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Home My WebLink About09-46810 IN THE COURT OF COMMOM PLEAS OF CUMBERLANDCOUNTY, PENNSYLVANIA JAMES W. TOMSA, Plaintiff No. Oq - glo8f 01VI( (erm v. NANCY CONKLIN, Defendant JURY TRIAL DEMANDED NOTICE TO DEFEND Pursuant to PA RCP No. 1018.1 Yorex, Pe??-svF?.vnrvu ??iOn YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth against you in the following pages, you must take action within twenty (20) days after this Amended Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so, the case may proceed without you and a default judgment may be entered against you by the Court without further notice for any money claimed in the Amended Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. LAWYER REFERRAL SERVICE OF THE CUMBERLAND COUNTY BAR ASSOCIATION CUMBERLAND COUNTY BAR CENTER 32 S. BEDFORD ST. CARLISLE, PA 17013 TELEPHONE: (717) 249-3166 EN LA CORTE DE ALEGATOS COMUN DEL CONDADO DE CUMBERLAND, PENNSYLVANIA JAMES W. TOMSA, No. Plaintiff V. NANCY CONKLIN, JURY TRIAL DEMANDED Defendant AVISO PARA DEFENDER Conforme a PA RCP Num. 1018.1 USTED HA SIDO DEMANDADO EN LA CORTE. Si usted desea defenderse de las quejas expuestas en las paginas siguientes, debe tomar accion dentro de veinte (20) dias a partir de la fecha en que recibi6 la demanda y el aviso. Usted debe presentar comparecencia escrita en persona o por abogado y presentar en la Corte por escrito sus defensas o sus obj eciones a las demandas en su contra. Se le avisa que si no se defiende, el caso puede proceder sin usted y la Corte puede decidir en su contra sin mas aviso o notificacion por cualquier dinero reclamado en la demanda o por cualquier otra queja o compensacion reclamados por el Demandante. USTED PUEDE PERDER DINERO, O PROPRIEDADES U OTROS DERECHOS IMPORTANTES PARA LISTED. USTED DEBE LLEVAR ESTE PAPEL A SU ABOGADO ENSEGUIDA. SI USTED NO TIENE UN ABOGADO, VAYA O LLAME POR TELEFONO LA OFICINA FIJADA AQUI ABAJO. ESTA OFICINA PUEDE PROVEERE CON INFORMACION DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGARLE A UN ABOGADO, ESTA OFICINA PUEDE PROVEERE INFORMACION ACERCA AGENCIAS QUE PUEDAN OFRECER SERVICIOUS LEGAL A PERSONAS ELIGIBLE AQ UN HONORARIO REDUCIDO O GRATIS. SERVICIO DE REFERIDO A ABOGADO COLEGIO DE ABOGADOS DEL CONDADO DE CUMBERLAND ABOGACIA DEL CONDADO DE CUMBERLAND CALLE MARKET #137 ESTE CUMBERLAND, PENNSYLVANIA 17013 TELEFONE: (717) 249-3166 IN THE COURT OF COMMOM PLEAS OF CUMBERLANDCOUNTY, PENNSYLVANIA JAMES W. TOMSA, No. 0 9- 4 4 91 Plaintiff V. NANCY CONKLIN, JURY TRIAL DEMANDED Defendant COMPLAINT 1. The Plaintiff, James W. Tomsa is an adult individual residing at 1184 McCabe Road, Landisburg, Perry County, PA 17040. 2. The Defendant, Nancy Conklin is an adult individual residing at RD 2 Box 41-C, Millerton, Tioga County, PA 16936. 3. On November 9, 2007, Plaintiff James W. Tomsa was the owner and operator of a 1996 Chrysler Concord bearing PA registration plate EWE2131. 4. On November 9, 2007, the Defendant was the operator and owner of a 2005 Nissan Sentra bearing PA registration plate EDG1074. 5. On November 9, 2007, at approximately 4:10 p.m., Plaintiff James W. Tomsa was operating his vehicle Eastbound on State Route 0581 approaching ramp for State Route 15 in Camp Hill Borough, Cumberland County. 6. At the same time and place, Defendant was operating her vehicle behind Plaintiff's vehicle Eastbound on State Route 0581 approaching ramp for State Route 15 in Camp Hill Borough, Cumberland County, when she failed to stop in traffic and collided with Plaintiff's vehicle resulting in injuries and damages to Plaintiff. 7. This accident occurred as a result of the negligence of the Defendant and was due in no manner to any act, or failure to act, on the part of the Plaintiff. 8. This matter is alleged to exceed the application limits of arbitration, and a °_ ° °°a° ss= jury trial is hereby demanded. Y.irsu, PP.v.EYLwrvw ?ns COUNTI JAMES W. TOMSA V. NANCY CONKLIN 9. The allegations contained in paragraphs 1 through 8, inclusive, are incorporated herein as fully as though set forth at length. 10. The negligence of Defendant Conklin consisted of the following; a. Failing to properly operate and control her motor vehicle; b. Failing to keep alert and maintain a proper lookout for the presence of other motor vehicles on the streets and highways; c. Following too closely in violation of 75 Pa. C.S.A. §3310. d. Failure to control her vehicle at a safe speed to avoid a collision in violation of 75 Pa.C.S.A. §3361 11. As the result of the negligence of the Defendant, the Plaintiff suffered permanent injuries including but not limited to neck and back injuries. 12. As a result of the negligence of the Defendant, the Plaintiff was forced to incur medical bills and expenses for the injuries he has suffered, and he will continue to incur medical expenses in the future. 13. As a result of the negligence of the Defendant, the Plaintiff has suffered, or may suffer, a severe loss of his earnings and impairment of his earnings capacity, and the loss of income and impairment of earning capacity will, or may, continue in the future. 14. As a result of the negligence of the Defendant, the Plaintiff has undergone, and in the future may undergo, great mental and physical pain and suffering, mental anguish and humiliation, loss of life's pleasures, and a severe limitation in his pursuit of daily activities, all to his great loss and detriment. WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter judgment against the Defendant in an amount in excess of the mandatory arbitration limits. RESPECTFULLY SUBMITTED: LAW OFY.I OF DALE E. ANSTINE, P.C. David M. Pollick, Esquire Attorney I.D. #34368 Two West Market Street P.O. BOX 952 York, PA 17405 (717) 846-0606 Y?nx. olsn??sri.wv?w'i?aon VERIFICATION I HEREBY VERIFY that the information set forth in the foregoing document is true and correct to the best of my knowledge, information and belief. I understand that any false statements contained herein are subject to the penalties of 1S Pa.C.S. 4904, relating to unsworn falsification to authorities. Date: or'? James Y. Tomsa DALH F.. tL Ytd mall N, J". Z'. 0 --T I 2?7q ka -478.50 Po AT?-/ Gc-# SaSg7 X179 tP4 JOHNSON, DUFFIE, STEWART & WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone: (717) 761-4540 E-mail: jrn@jdsw.com Attorney for Defendant JAMES W. TOMSA, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-4681 Civil Term CIVIL ACTION - LAW NANCY CONKLIN, Defendant JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: PLEASE enter the appearance of the undersigned as counsel of record for the Defendant in the above-captioned matter. Respectfully submitted, JOHNSON, FFIE, STEWART & WEIDNER By: ZAk Date: September 9, 2009 376638 Johe R. Ninosky, Esquire Attorney I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorney for Defendant CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing' Entry of Appearance has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on September 9, 2009: David M. Pollick, Esquire Law Offices of Dale E. Anstine, P.C. Two West Market Street P.O. Box 952 York, PA 17405 JOHNSON, DUFFIE, STEWART & WEIDNER At 'f /J""z By: Jo R. Ninosky, Esquire 1 ILE V? OF THE PROTPnNOTARY 2009 SEP 10 PH 12: 09 PENNSYWV,,? IA JOHNSON, DUFFIE, STEWART & WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone: (717) 761-4540 E-mail: jrn@jdsw.com Attorney for Defendant JAMES W. TOMSA, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-4681 Civil Term CIVIL ACTION - LAW NANCY CONKLIN, ; Defendant JURY TRIAL DEMANDED NOTICE TO PLEAD TO: James W. Tomsa, c/o her counsel, David M. Pollick, Esquire Law Offices of Dale E. Anstine, P.C. Two West Market Street P.O. Box 952 York, PA 17405 YOU ARE REQUIRED to plead to the within Answer with New Matter within 20 days of service hereof or a default judgment may be entered against you. JOHNSON, DUFFIE, STEWART & WEIDNER By: Date: September 21, 2009 Jolhn R. Ninosky, Esquire Attorney I.D. No. 78000 Counsel for Defendant Conklin JOHNSON, DUFFIE, STEWART & WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone: (717) 761-4540 E-mail: jrn@jdsw.com Attorney for Defendant JAMES W. TOMSA, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-4681 Civil Term CIVIL ACTION - LAW NANCY CONKLIN, Defendant JURY TRIAL DEMANDED ANSWER WITH NEW MATTER OF DEFENDANT NANCY CONKLIN TO PLAINTIFF'S COMPLAINT AND NOW, comes Defendant, Nancy Conklin, by and through her counsel, Johnson, Duffie, Stewart & Weidner, P.C., who files this Answer with New Matter to Plaintiff's Complaint by respectfully stating the following: 1. Denied. After reasonable investigation, the answering Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in this paragraph. The same are therefore denied, and strict proof demanded at the time of trial. 2. Admitted in part; denied in part. It is admitted that Defendant is an adult individual who resides at RD 2, Box 41-C, Millerton, Pennsylvania. It is denied that Defendant resides in Tioga County. To the contrary, Defendant resides in Bradford County. 3. Denied. After reasonable investigation, the answering Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in this paragraph. The same are therefore denied, and strict proof demanded at the time of trial. 4. Admitted. 5. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 6. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 7. Denied. The averments contained in this paragraph contain conclusions of law and fact to which no response by the answering Defendant is required. If an answer is deemed required, the averments contained herein are denied. 8. Denied. The averments contained in this paragraph contain conclusions of law and fact to which no response by the answering Defendant is required. If an answer is deemed required, the averments contained herein are denied. By way of further answer, the alleged accident was not a substantial factor in causing the Plaintiff any harm. COUNTI JAMES W. TOMSA v. NANCY CONKLIN 9. Defendant incorporates herein by reference the answers to paragraphs 1 through 8 above as though fully set forth herein at length. 10. Denied. The averments contained in this paragraph and subparagraphs a. through d. contain conclusions of law and fact to which no response by the answering Defendant is required. 11. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 12.1 Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 2 13. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 14. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). WHEREFORE, Defendant, Nancy Conklin, respectfully requests that Plaintiff's Complaint be dismissed with prejudice and that judgment be entered in her favor. NEW MATTER 15. Plaintiff's Complaint fails to state a claim upon which relief may be granted. 16. Plaintiff selected the limited tort option for his personal automobile insurance. 17. Plaintiff's claims and/or alleged losses may be barred or reduced by his selection of the limited tort option. 18. Plaintiffs claims and/or alleged losses may be limited and/or barred by his own comparative negligence. 19. Plaintiff may have failed to mitigate his damages, if any, with any liability or responsibility on the part of the answering Defendant being expressly denied. 20. The alleged accident was not a substantial factor and/or factual cause of any injury alleged by Plaintiff. 21. Plaintiff is barred from recovering non-economic damages. 22. Plaintiff has not experienced any economic damages as a result of the alleged incident. 3 WHEREFORE, Defendant, Nancy Conklin, respectfully requests that Plaintiff's Complaint be dismissed with prejudice and that judgment be entered in her favor. Respectfully submitted, JOHNSON UFFIE, STEW T & WEIDNER By: J n R. Ninosky, Esquire Attorney I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Date: September 21, 2009 4 VERIFICATION I, Nancy Conklin, have read the foregoing Answer with New Matter, and hereby affirm that it is true and correct to the best of my personal knowledge, or information and belief. This Verification and statement is made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities; I verify that all the statements made in the foregoing are true and correct and that false statements may subject me to the penalties of 18 Pa. C.S. §4904. Nanc Con Date: / 377113 CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Answer with New Matter has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on September 21, 2009: David M. Pollick, Esquire Law Offices of Dale E. Anstine, P.C. Two West Market Street P.O. Box 952 York, PA 17405 JOHNSON, DUFFIE, STEWART & WEIDNER By: t /,4w Joh R. Ninosky, Esquire ;"`Y # 1r 4 .) r Z" IN THE COURT OF COMMOM PLEAS OF CUMBERLANDCOUNTY, PENNSYLVANIA JAMES W. TOMSA, No. 09-4681 Plaintiff V. NANCY CONKLIN, JURY TRIAL DEMANDED Defendant PLAINTIFF'S REPLY TO DEFENDANT NANCY CONKLIN'S NEW MATTER 15. Denied. Constitutes a conclusion of law to which no reply is deemed necessary. 16. Admitted. 17. Denied. Constitutes a conclusion of law to which no reply is deemed necessary. 18. Denied. Constitutes a conclusion of law to which no reply is deemed necessary. 19. Denied. Constitutes a conclusion of law to which no reply is deemed necessary. 20. Denied. Constitutes a conclusion of law to which no reply is deemed necessary. 21. Denied. Constitutes a conclusion :)f law to which no reply is deemed necessar?. 22. Denied. Plaintiff has or may exceed his available coverage for medical and wage loss expenses. WHEREFORE, Plaintiff demands judgment in his favor and against the Defendant together with costs and interest as allowed by law. DAH m E$ A-xnTllSW. P. 1% Yeas. Pen rvsn?wv?ws ?>xua Respectfully submitted, LAWs6FFI'CES OF DALE E. ANSTINE D?. Pollick, Esquire Attorney I.D. #34368 Two West Market Street P.O. Box 952 York, Pennsylvania 17405 (717) 846-0606 DA ?N E. P. V. 1'oreu. oPe rervkxivwxu iiau.? CERTIFICATE OF SERVICE AND NOW, this A5-day of QC3t-N r, 2009, I hereby that I have served a copy of the foregoing Plaintiffs Reply to Defendant Nancy Conklin's New Matter be depositing true and correct copies of same in the United States Mail, postage prepaid, addressed to: John R. Ninosky, Esquire Johnson, Duffie, Stewart & Weidner, P.C. 301 Market Street PO Box 109 Lemoyne, PA 17043-0109 Respectfully submitted, LAW,OPFICM QF-DALE E. ANSTINE David M"Pollick, Esquire Attorney I.D. #34368 Two West Market Street P.O. Box 952 York, Pennsylvania 17405 (717) 846-0606 DA?kl E. Awnwaxo, P. 1% 2103 OC t N pi "I . G R Thomas Kline Sheriff Ronny R Anderson Chief Deputy Jody S Smith Civil Process Sergeant Edward L Schorpp Solicitor Sheriffs Office of CumberlandFM&E "' E OF 1H_ Fv l - .r l i ['.'C ! t t J James W. Tomsa vs. Nancy Conklin Case Number 2009-4681 SHERIFF'S RETURN OF SERVICE 07/17/2009 R. Thomas Kline, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Nancy Conklin, but was unable to locate her in his bailiwick He therefore deputized the Sheriff of Bradford County, PA to serve the within Complaint and Notice according to law. 08/31/2009 11:32 AM - Bradford County Return: And now August 31, 2009 at 1132 hours I, Steven A. Evans, Sheriff of Bradford County, Pennsylvania, do herby certify and return that I served a true copy of the within Complaint and Notice, upon the within named defendant, to wit: Nancy Conklin by making known unto herself personally, at RD2 BOX 41-C Millerton, PA 16936 its contents and at the same time handing to hei personally the said true and correct copy of the same. SHERIFF COST: $37.44 October 20, 2009 SO ANSWERS, ( R THOMAS KLINE, SHERIFF AMADFORD COUNTY, PENNSYLVANIA It. I COURTHOUSE, 301 MAIN ST., TOWANDA, PA 18848 Steven A. Evers, Sheriff Clinton J. Walters Chief Deputy PH. 570-265-1701 FAX 570-265-1734 SHERIFF SERVICE PROCESS RECEIPT, and AFFIDAVIT OF RETURN DOCKET# PLNTF 09-CON-118 NO JAMES W. TOMSA DEF Type of case NANCY CONKLIN NOTICE 41-C MILL.ERTON, PA 16936 NOW, , 20_ 1, SHERIFF OF BRADFORD COUNTY, PA do hereby deputize the Sheriff of County to execute this Writ and make return thereof according to law. This deputation being made at the request and risk of the plaintiff. SHERIFF OF BRADFORD COUNTY t•••• SPECIAL INSTRUCTIONS OR OTHER INFO THAT WILL ASST. IN EXPEDITING SERVICE: **PERSONAL SERVICE ONLY** SPACE BELOW FOR USE OF SHERIFF ON LY - DO NOT WRITE BELOW MIN LINK ATTY OR ORIGINATOR REQUESTING SERVICE DATE RECEIVED: HEARING EXPIItATION DATE DALE E. ANSTINE 8/3/2009 9/312009 PHONE ## OF ORIGINATOR (570) 846-0606 I hereby CERTIFY and RETURN that I have uersonaft seried have served person in charge, -served by: the writ or complaint described on the individual, company, corporation, etc. at the address shown above or on the individual, company, corporation, etc. at the address inserted below by handing (or posting) a TRUE and ATTESTED COPY THEREOF. I hereby certify and return a NOT FOUND because I am unable to locate the individual, company, corp., etc. named above. _A person of suitable age and discretion then residing m the defendaffi's imud place of abode. LOCATION SERVED: TIME SERVED: DATE SERVED: 3? q0 0< 41 ( 'ILL. h ?? 3? 1 3? attempts. $x-71 0j 00 d0cw service > notal-T mcbmw l - toto "sb co* "e D and subscribed to//b/e?fy/?/o.?r/\/e me this ? 30 AN3 R I J at 'I day of 0 1 W F A ?T - Q Date: NOTARY: wouRAIL SEW MY j. a N0ThRY PUBLIC Date: s MY COMMISSION EXPIRES li BORO BRA? aR COUNTY Due date:: X IRES JUNE 30. 2010 .-IV te,Court of Common Pleas of Cumberland County, Pennsylvania /James W. Tomsa Nancy Conklin RD 2 BOX 41-C Millerton, PA 16936 Vs. Civil No. 2009-4681 Now, July 28, 2009, I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Bradford County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. ro%K"Ae-?&? Sheriff of Cumberland County, PA Affidavit of Service Now, X 11.6.4 3 , 20 Q at (? o'clock M, served the Alikeoc within upon ? Y4nr 7 at 2OJ 84x 41-C /y1 d/,,k , PA /jf3j by handing to___L a , and made known to copy of the original f )A144 the contents thereof. So answers, Sheriff of Sworn and subscribed before me this day of ,20 COSTS SERVICE_ MILEAGE_ AFFIDAVIT County, PA COUNTY OF C AI`Ib r1 nG? OFFICE OF THE SHERIFF 45 N. GEORGE ST., YORK, PA 17401 SERVICE CALL (717) 771-9601 SHERIFF SERVICE INSTRUCTIONS PROCESS RECEIPT and AFFIDAVIT OF RETURN PLEASE TYPE ONLY LIVE 1 THRU 12 DO NOT DETACH ANY COPES 1 LAINTIFF/S/ 2 COURT NUMBER 2009-4681 ?rl ?M ac F 1 _-- 3. t. IT tt OF VVKI1 UK L.UMMLAIN I ('Iku 1 COMPLAINT SERVE 5 NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC TO SERVE OR DESCRIPTION OF PROP RTY T BE LEVIED, ATTACHED, OR SOLO ro. 6 DR S (ST OR RFO WITH BOX NUMBER, APT NO. CITY. BORO. TWP, STATE ANO ZIP CODt) • C.L? r 1 Cn cr?Co 7. INDICATE SERVICE ERSONAL U PERSON IN CHARGE U DEPU IZE CERT MAI U 1ST CLASS MAIL U POSTED '-1 OTHER NOW JULY 17 , 20 09 I, SHERIFF O COUNTY, PA, do hereby deputize the sheriff of Zwob=X BRI?DF0Rn COUNTY to execute ake return -according to law. This deputization being made at the request and risk of the plaintiff., 01 SHERIFF 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE. **PERSONAL SERVICE** Pi' lI OT NOTE: ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN - Any de levying upon or attaching any property under within writ may leave same without a watchman, in custody of whomever is found in possession, after notifying person of le or attach wr t liability on the part of such deputy or the sheriff to any plaintiff herein for any loss, destruction, or removal of any property before sheriffs sale thereof 9. TYPE NAME and ADDRESS of ATTORNEY / ORIGINATOR and SIGNATURE 10. TELEPHONE NUMBER 11 DATE FILED dJ 1 12. SEND NOTICE OF SERVI E CO NAME A ADDRESS BE W: (This area must be completed if notice is to be mailed) CUMBERLAND 00. SHERIFF '-SPINE BELOW FOR USE Ot TillfSFfRI>FF _ DO NO O S L CARLISLE, PA 1701 13. 1 acknowledge receipt of the writ 14. DATE RECEIVED 15 Expiration/Heanng Date or complaint as indicated above. 16. HOW SERVED: PERSONAL( ) RESIDENCE ( ) POSTED( ) POE( ) SHERIFF'S OFFICE ( ) OTHER ) SEE REMARKS BELOW 17. O 1 hereby certify and return a NOT FOUND because I am unable to locate the individual, company, etc named above. (See remarks below.) 18. NAME AND TITLE OF INDIVIDUAL SERVED / LIST ADDRESS HERE IF NOT SHOWN ABOVE (Relationship to Defendant) 19 Date of service 20 Time of Service 21. ATTEMPTSI Date I Time I Miles I Int ' Date I Time I Miles I Int ' Dale I Time I Miles I Int 1 Date Tone Miles Int. Date Time Miles Int Date Time Miles Int 22. RECEIVED AUG 0 3 2nng RRADFOW' ^G,: w SHERIFF'S C)FFV,'e 23. Advance Costs 24 Service Costs 25 N/F 26. Mileage 27 Postage 28 Sub Total 29. Pound 30 Notary 31 Surchg. 32 Tot. Costs 33 Costs Due or Refund Check No 34. Foreign County Costs ' 35. Advance Costs 136 Service Costs 137 Notary Cert . 138. Mdeage/Postage/Not Found 39 Total Costs 40 Costs Due or Refund 41. AFFIRMED and subscribed to before me this SO ANSWERS 44. Signature of 45. DATE 42 day of 20 _ 43 Dep. Sheriff PROTHY !NOTARY 46. Signature of York 47 DATE County Sheriff 48 Signature of Foreign 149 DATE County Shenff 50. 1 ACKNOWLEDGE RECEIPT OF THE SHERIFF'S RETURN SIGNATURE 51 DATE RECEIVED OF AUTHORIZED ISSUING AUTHORITY AND TITLE 1. WHITE - Issuing Authority 2. PINK - Attorney 3. CANARY - Sheriffs Office 4. BLUE - Shentfs Office ? ? ?,;? :_ x _ ..<u: 4 ?? :, _ w.:. , s. ... ....;-. ,_..+x.r"„?-?urME.!!?'tw3'ki4'+IY9?'7Rtx• .. ?'.. JF .r.. .. .. ., .... .,.. s.. .: ?..yv ), 2~4Q J~~ ~$ C19 ~~ ( 4 ~"1~~,it~,v`;`~.1JAi~,fi{~~, JOHNSON, DUFFIE, STEWART 8a WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 By: Andrew J. Petsu, Jr., Esquire I.D. No. 206495 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 JAMES W. TOMSA, v. NANCY CONKLIN, Plaintiff Defendant NO. 09-4681 Civil Term CIVIL ACTION -LAW JURY TRIAL DEMANDED DEFENDANT'S MOTION FOR SUMMARY JUDGMENT AND NOW, comes the Defendant, Nancy Conklin, by and through her counsel, Johnson, Duffle, Stewart & Weidner, P.C., who files this Motion for Summary Judgment by respectfully stating the following: 1. This matter arises from an automobile accident which occurred on November 9, 2007. See, Plaintiffs Complaint filed on July 14, 2009. 2. The accident happened when Defendant's vehicle hydroplaned on the exit ramp from State Route 581 to Route 15 in Camp Hill, Cumberland County, and struck the rear of Plaintiff's vehicle. 3. Defendant does not deny negligence in the happening of the accident. 4. At the time of the accident, Plaintiff had selected the "Limited Tort" option on his personal automobile insurance policy with Encompass Insurance. See, a copy of the applicable Attorney for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Declarations Page is attached hereto as Exhibit A. 5. Defendant asserted in her New Matter that Plaintiff's claims and/or alleged losses are limited or barred by his selection of the Limited Tort option. See, Defendant's Answer with New Matter filed on September 22, 2009. 6. An individual who selects the Limited Tort option is precluded from recovering non-economic damages unless an injury causes a serious impairment of a body function. See, 75 Pa.C.S.A § 1705. 7. "The `serious impairment of body function' threshold, which must be met for limited tort elector to maintain action for non-economic loss arising from motor vehicle accident asks (1) what body function, if any, was impaired because of the injuries sustained in a motor vehicle accident, and (2) was the impairment of the body function serious." Washington v. Baxter, 719 A.2d 733 (Pa. 1998). 8. "Several factors must be considered to determine if the claimed injury is a "serious injury" for purposes of limited tort option threshold for recovery of non-economic damages: (1) the extent of the impairment; (2) the length of time the impairment lasted; (3) the treatment required to correct the impairment; and (4) any other relevant factors. Graham v. Campo, 990 A.2d 9 (Pa. Super. 2010). 9. Plaintiff claims she suffered a low back injury, which was diagnosed as a C-spine strain, as a result of the accident. (See, treatment records and Tomsa deposition attached hereto as Exhibits B through F). 10. It is submitted that the injuries allegedly suffered by Plaintiff do not demonstrate a serious impairment of bodily function. 2 11. Pennsylvania Rule of Civil Procedure 1035.2 governs Motions for Summary Judgment: ...any party may move for summary judgment in whole or in part as a matter of law (1) whenever there is no genuine issue of any material fact as to a necessary element of the cause of action or defense which could be established by additional discovery or expert report, or (2) If, after the completion of discovery relevant to the motion, including the production of expert reports, an adverse party who will bear the burden of proof at trial has failed to produce evidence of facts essential to the cause of action or defense which in a jury trial would required the issues to be submitted to a jury. Pa. R.C.P. 1035.2 (1996). 12. The standard of review under Rule 1035 normally requires the Court to deny summary judgment unless the case is clear and free from doubt. Redland Soccer Club v. Department of Army. 548 Pa. 178, 696 A.2d 137 (1997). 13. Moreover, summary judgment is generally warranted if, on review of the entire record, the trial court determines that there is no genuine issue of material fact. Snyder v. Specialty Glass Products. Inc.. 441 Pa. Super 613, 658 A.2d 366 (1995). 14. It is submitted that Plaintiff cannot recover non-economic damages in this case, because he has not suffered an injury which has caused a serious impairment of a bodily function. See, Tomsa Deposition attached as Exhibit F). 15. Plaintiff has no claim for economic damages. 3 WHEREFORE, Defendant respectfully requests that this Honorable Court grant her Motion for Summary Judgment and that Plaintiff's cause of action be dismissed with prejudice. Respectfully submitted, JOHNSON, D FIE, STEWAR & WEIDNER By: `-" ~ 12 John . Ninosky, Esquire Attorney I.D. No. 78000 Andrew J. Petsu, Jr., Esquire Attorney I.D. No. 206495 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Date: June 25, 2010 400558 4 MAY-22-2008 THU 09 46 AM x-0167 P, 01 ' .1 M s9'• •4l' p: q • M •p ~~' - ~~~: ' 8FI7RLEY M ~MCGO'TLLIAMB ~' ~~~- RiT!'dBA1f7GIi INS[JRA1~T~'E; ' JAMES, W T~MI#5 '95~.. C,~RI;ISI,El. ~T1ZFE1' 35 COr.,gNll\L DRIVE; OIpER PA .1,7331 FIANO'(1'k;R. PA 173,3.-9371 ~ 1P~l7NT: 717632-6001 O::b-1104 -•OODb• i . .• ( Policy 'NUmti13r: a°~rdY Period:.: ~~ f~oilcyFio:rtler- •SlriCe 236'85d75Z o.6' 2`7'jZq'p7 to• t}6/27/ZO0.8 1~;Q•T~~I~IVIi~$tefldartf•1'lrna lls%~.R-o"7~ . lnsuran~e Prov'lded By: j Encbm}~ass. IndPrnnit:y. Company ~ 24: ~Ot~R CLAIM Rg~03~'~'Ik1C 8011-588`-'7~40D 2'775 Sax~dere Rd _ ; ATorthlo~'opk, :IL 60'062-6127 • . . !. ~ . ° YOUR POLICY •:Nr1S. B~'EPl'CHAt~G>rD I. '. Th'e deleti.oii of one or mtSrE' •ve'h'iales• • i • _ . Replaced v8hicle: CFIRYSL~R COATCOI2J]E. `witkt veha.cl.e N•~55AN ALT2MA Revised Anr-USt Policy premium ' •$ S ;, fl 83 , 00. , . Additional Premium for Coverages Frprrl 22/le j2oD7 to 46/27 2008 ~ 7z : DD `~ iM~io~z-r~crur iN~~iiac'r~o• 'd~'~ir~rfi':'~rQt INS t?tztirrlb,>", cn~UI~CoN :~CC)~f ~'~ Cit~l~il~Cil b~f Nq' TIiF. ~~ bF:TFf • }' ~~~ ~ . ...~, ;, , ~ cov~~'~tr:..' ~,ri~i= •co~~:ts~o~i' >~ o~~~~Gt~>:iiv~:R'~o~ PLEASP'REVI~IN YOUR' POLICY ~t~R •~bVt~I~GiW'.~Dl Ther's Is not s trampoline locateld on yd'ur property. Ypu. do .not haves a .woodtiurning~ '>stove. 1U1071?l4 VEHrCLE 'PRt:?'~'EC~'IQN ~N'r~~ ,av• You; . Z~DIt~C; EiBLE-) onty It•a~ prarrifut», or•'thnTt ,hovi-ii,~ , Vehlcla~ 1 ~ Vehicle 3 besOrtptlon: 199.6 c7BE]? GRND' C73>3RdKE `, ~ 20U1 •NI,~SAN' Ay~'ZJ~Fi VI1V: l.T4GZ6~8SD'i'Q239.018 11aI4DLD1D61~1'~•613Z ' Rated' Delver: SHIRIrS'i' M t/lCWI~L~~1M$ t7A1'4E8 W !C'4MT1g Uset Plork 3.1-9.9 WQrk 0-3 ! Claes Code: ~ 23T6 228 • :.:.. BODILY fNJURY D ' od,ooD/3ria•;aoo $`. •70,DD • (per person/p:~r accldertt) PRDPE=RTY DAMAGE $ 100•, doo S ~3 _ oo S loo, pon S 55 , oo ' (per raccidaht) • LIMITED TORT OPTION Applies Rppl isd 236854752 Proddont ~~~ S6tY6l8fY Continued on N6Xt ~'(~~"1~~~r• .' ".' ;`'sr~b~p!'.tt3~•'n.':`~f~~s-:;ci ~` st~6:~ ;': •~o ~H~'t~oiitt~st~"1u*~iscieta TCMAS, JAMES W-Enc #280117269-OPT-HER-11/9/2007 EMS Report - 12/7/2007 - 3 pg 1~ ~ ~~ ]1/092007 22:57 7177372708 CAMP HILL FIRE DEPT Penasylvania EMS Report PAGE 01 8erviae Nnae 9ta11oa Urk Natae 4 Ne. FCR No. Date Hlll F' A•I4 - 4 0701 0 11/098007 Lddat Leatloa Mraldpality lc Iocidavt zlp i~ [rda. No. Rt S81 ]r, A9.159 Capp Hltl, PA 17011 Came Hill Boro,17011 070147489 1~ o<r Hrrriabur8 HosPiw P.tleat Nacre ~ / Cmr ~ a ~ James Tamaa (p C N! Shadier, Down E 197343 w C 333 C.o4mial Drive C M3 ICepea, Llaa ); 000866 C At3 t ~, ~~ p ~ Hanovrr PA 17331 C s4 4Qi 4 ? .~r Male ~Years )?nS11963 ( l7) 275-4782 Tltaa CQ ]!adaat aeber gee. a Pt t 911 iZl ]bd-64-2497 Dbp~tc~ I6:15 17 E a Drtver'a Llcerae arvatt 16: Arrtre Sceae 16:23 U~,n Costaet 16:23 7Yfarpatlq AaeYt OS t Oa~eeae Dear. ]s Dspart 6ceae 16;43 68813 68816 68820 68824 ArrWe 16:3D i Rapoaw Oata-me Ital Coomaad Phyaldaa M Tiac Ar. lalyk 17:34 to QMaetas Tronspated t':-le[ Coaopilaht: Bad: Pain add Neck Pain CattsatMeds: None-per PL Allet~ea (.eda>: A ~: Kaae 9urg~y, Right Arm Surgery, Gesteric By-Psis Level aiCou~tinae Speech Neurolagkal Sftlnr Temperature d Cobr 0 Cotueioua 0 Oriented x 4 0 l;oherrnt 0 No Complaint ®Dry ®PiaY ^ MoWod ® Alert [] Urooope~re ^ lnooheront ^ Headache ^ N:mbocsr [~ Muiu ^ Pale ^ Cyatofia D LetbaBic ^ Conrbatlve ^ silertt ^ StilYNedc ^ Wealooeaa ^ Dlaphorede u Fluahea p Yellow ^ Confwed [] Ahmed [~ Cryi:~ ©Neck Pain ^ Diay (] Asbcn ^ Outer ^ Uacooaciau ^ Hyaterinl t.-r Shared ^ byaphaaia Q Gait-Uaateody ^ Ittfiat ^ Aphasia Facial Droop - L O R O Hot O warm ~ Cool O Cold O Ctaspirarb°ry B,+eatY Sorra. Csrdlova~enlttr Pupi4 H$ENT ® Ne Caa~laiata L R Ckeat Pain 0 PERL $yN No Lunt ^ Airwey Patart PeeeerY 0 ® 0 No Compleint Sire L R Blurred vision • L ^R^ ^ Symmetrical Abeent ^ ^ ^ Stwert~ Double Viafoa - L QR[] ^ LaDoid ~"r ~ 0 _ ^ Constiat ^ intetminent ~OpOaa ^^ Photopbolxa - L QR Q ^ Rstrwtxiom Drmieiabed ^ ^ ~~ ^^ D shrp ^ BuminB ^ Strtdor Wheves ^ ^ ^ Dull ^ Pleuritic Fixed ^^ $a1C3 o D1~ ^ Naaal Flarirt; Credda ^ ^ ^ Heavy ^ RadLtiog 31u~uh ^^ Pnin , L ^R ^ CeoR,6 Rltonciti ^ ^ Non•Rpetive ~][] ~~ • LDR^ 0 No l,.oatpL-iot Aaymmetrk I"t ^ I..J ^ Capillary Refill =" _ Knowm AaomalYO^ Blood - L ^R ^ Producttvc - No p Yx O NOtsO ®No Complaint ^ Naal Coegaatioe Throat 0 No Complaint ^ Nual Drainage ^ 3oro Throat ^ DyspbaYio Deviation • L O R O EpiMaxia - L © R [~ ^ Drooling p Swrolling/Edema ^ ND ^ Defbrmiry Printed On: 17/09/2007 18:27 EMStat Reporting(c) 1998.2007, Med-Media, Inc. All Rights Rnsaved `~ a Fr F~ O "+~ N W W ~b w••- l Provider age: 1 of 3 Page 1 of 3 TOMAS, JAMES W-Enc #280117269-OPT-HER-11/9/2007 EMS Report - 12/7/2007 - 3 pg ___.. i___.... ).1/0572007 22:57 7177372708 CAMP HILL FIRE DEPT Pennsylvania EMS Report PAGE 02 Niure Uelt No r'CA Na Dase g~ ~, A- ~ - 2100114 70 120 11/09/Z007 ?atiert Nras Date eflirtti SocW 9eetniq Nr~ber PSAP Jame Tomq IZlZS/1%S 1644-2493 070147489 Gat+trohtbstiaal Abdomen Pain GU ~o Coa~plaaot D Nt~mea ^ vosurtul6 ®So1t [] Fum ~ Constant ^ Intcttnittcnt 0 No Complaint ^ v~sa"°v D Ftsyueaer ^ D3aetba. ^ Coaatiprkd ^ awrait~ ^ ~6 Q seatp s D e ^ ^ 9 w ~ s Absent nd ^ Du11 a t ~ o . ou s D ^ ~~~ a D~ Q R DiheuBed • No C$ Yci O Radf~tin8 - No O Yep O F D °y ^ uQ ^ ~Q Teadar • No C~ Yes O Told Output -.- $:tremLlia Reprodactive ®Na Complawa ~/] No Camplamis Fsm e a 1.A aw 1.J.. Ri 1.A RA 11. xi ^Vteied Biaedatj DDi,dtr8o ^ Pmtls DLcnarae ~Y~ [,~ [~ [~ ^ Pam ^ ^ [] D Propfaot • No O Yes O ^ Testleular Pabt PrtaQ~a~sla ^ ^ ^ D ~~ D Q D ^ onNta. _ Para _ weak _ pug ^ a ^ D D ^ D D Dpi M F~ ~tT~ - Narrative Dispatched by Cumberland Med, along with Ambulance 385, to the above location for an auto accident unknown injuries, class 2 response. PAI: Cumberland Med advised ca11 was received by PSP- Harrisburg, unknown in}cries, unknown number of vehicles involved. All hospitals are open. AOS: to find 3 vehicles alongside the road. Pt. was still in the driver's seat of the vehicle. Pt. appeared to be conscious, alert, and breathing without difficulties. Pt. did not appear to be in any distress. PHI: Pt. stated that they were stopped on the exit ramp, whenever the vehicle was rear ended causing the vehicle to hit the vehicle in front. Pt. stated that he is having back pain is the upper part of his back. Pt. stated that he was wearing her seatbelt. Pt. stated that both air bags did deploy. Pt. stated that he was the driver of the vehicle. No gross bleeding noted. Condition of vebiele: Pt. vehicle had minor damage to the rear and to the front. Noted dual airbag deployment. Noted driver's seat back was broken and laying against the back seat. PE. Pt. was AA8t0 x4. No grass bleeding noted. Pt. skin was warm, pink and dry. Pt. pupils were PF.RRL. No CSF noted in the ears or nose. No DCAP-BYES noted to pt. head, neck, or chest. Noted no DCAP-BYES to the pt back. Pt. voiced pain and rated it a 6/10. No JVD or tracheal deviation noted. Pt. denied any chest pains or shortness of breath. Pt. chest was of equal rise and fall with no paradoxical movement noted. Pt. lung sounds were present and clear. Pt. abdomen was soft, noa- tender, with no distension noted. Pt. was able to move all extremities without difficulties. No DCAP- BTLS noted to the pt. upper or lower extremities. Pt. upper extremities showed no signs of edema and PMS was equal. Pt. lower extremities showed no signs of edema and PMS was equal. Vital signs were Princes on: 11/09rzooy ls~~ >;MStat Reportiag(o) 1996-zom, l~sea-a~i., iao. ,w xigl,n xeaeNed 0 r Mri 0 v~ rr W ~D Pro der e: 2 of 3 TOMAS, JAMES W-Enc #280117269-OPT-HER-11/9/2007 EMS Report - 12/7/2007 - 3 P9 ~ar~ _ f, 51/09/3007 22:57 7177372708 CAMP HILL FIRE DEPT PAGE 03 PeaasyZvan~a EMS Report BerrltxlVnee tF>titNo lCRNa Dats Hi p Co, pHg A•]4 -2100114 0101120 111091200') 7lstlsaft Name base of Huth Boelal 6ecsuit~ NsseDer P5AP ~ Jomn Tosma 12!25/1%S 164-ti4-2493 070147489 assessed, BP 142194, P 84, R 18. Treatme~tt/Trlualwrt: Pt. was assessed. C-spine inamobili22stion was established. A c-collar was put into placx on the pt. Pt. was placed on a back board and secured via spider straps. CID's were put into place and secured. Pt. was moved to the litter via the back board. Pt. was secured to the litter via Z straps. Pt. was taken nut to the ambulance,.plaetd inside and secured. Pt. vials wera assessed during transport to Harrisburg Hospital. Pt. remained in stable condition during transport. A med patch was given to the hospital on Dauphin Med 2. Pt. was taken into the ER and place in a hallway bed. A bedside report was given to ER nurse and pt, cars was transferred. Pi~ was unable to sign the HIPPA form, due to being inamabiliDOd. Pt. gave verbal perlnisaion for his girlfriend, Shirley McWilliams, to sign for him. Pt. girl~'riend signed the HU'PA for and was given a copy. Ambulance 14 went available without incident. Dawn Sheaffer EMT 197345 Ptnntnd C+n: 11/098007 187 EM5te1 Reportin®(a) 199-2007, Mel-Mello, Lac. AU Rights R+eoet~ed v w O a N ~..- W 1p h+ Previdac a 3 of 3 EXH/BI T "C" 'TOMAS;,JAMES W-Enc #280117269-OPT-HER-11/9/2007 ED Facesheet - 11/12/2007 - 1 pg ~r ~~ Harrisburg Hospital. 1 1 /09/07 800149077 2801 17269 ' , 111 S. front St. TOMSA ,JAMES W M ' Harrisburg PA 17141 1 g2/25/19~[65(( 'I ~} II II pp ' EMERGENCY DEPARTMENT II~IB~IIIII~~IIIIIIII~IIIIIIIIIII~II~III~IlIA~~IIIIIIIIIIIIIII Age Date of Birth Sex Date Time 41 12/25/1965 M 11/09/07 17:10 Primary Care Phys: SSN Chief Complaint: 164642493 MVA Dr. Time In ~G~ ' • ~ Police Notified: pYes ^ No By: ^ Medical Command DatelTime Accident: ~~ Chief Comp: HPI: Location: Quaiity/Severity Timing/Duration Context: Modifying Factors: Assoc Symptoms: ROB: UneDl6 to oDlsin b9C6we Const: Psych: EYES: ENT: Res p: CV: GI: GU: MS: I nteg: ~~i~ ~'G2~ ~~ Neuro: ' ,it Endo: Hem/Lymph: ' All/Immun: ^ 'All other systems negative" ^ See nurse's note -reviewed Hx: , . Allergies:. ,. , Meds: Medical: '°! , Hx, cont: Family: Social: Tobacco: Drugs: ETOM: Living Situation: PE: BP ! P R T SpOs Wt Q See nurse's note -reviewed Const: Mental Status/Psych: EYES: ENT: ~ • , ,~ Head/Neck: Resp: CV: GI: GU: Integ: Neuro: MS: ~, .. Lymph: ' ED Course: Test Interpretation: O L' ~~ ' Procedures: ~G,~ Dx: Service/MD Bed Tvpe Follow-Uo Referral Consult ^ Co di ion on Dischar e ^ Admission. ^ Med/Burg Stable Reminder: D: Transfer O Telemetry ~~~ Name Improved . ,~ Complete PQRI ^ Observation ^ Critical Care / /, ~ ^ Other form for bx of AMI, ischarge ^ Psych Time Syncope, and CAP EiD. Physician !/f /" ~~`~/ Physician's Assistan .Mid-level, Practitioner FOF2M 537 . •:' " _ (IIII ` IIIIS. V 1Ul~l ~IItI III Ill{ (~~I 187 ER Private Physician Resident/Student 1~ ~ ~~~ ~~ ©.~"~" "`- CC Minutes: .~~ Dictate ~Q Page 1 of 1 T.OMAS, JAMES W-Enc #280117269-OPT-HER-11/9/2007 Consent for Treatment - 11/12/2007 - 1 pg K ,~ o ~ ~ , CONSENT FOR TREATMENT ~ 1 1 /09/07 800149077 2801 17269 ' ~ Harrisburg Hospital TOMSA JAMES M • 111 S. Front St. Harrisburg PA 17101 12/25I/II1II~91l6nn5 0II01((9II3(~ III ~~ ~IB ~UI~III II~ ~~Il ~~'t~~l illl II~ CONSENT FOR TREATMENT- I consent to the rendering of medical care, which may include diagnostic procedures and such medical treatment as my attending or consulting physician considers to be necessary. I also understand that, absent emergency circumstances, no invasive or experimental procedure will be performed upon me unless or until I have had an opportunity to discuss the procedure with my physician and give Informed consent to the procedure. I understand that the practice of medicine and surgery is not an exact science and that diagnosis and treatment may involve risk of injury or even death. I acknowledge that no guarantee has been made to me regarding any examination or treatment in this hospital. PRE-CERTIFICATION REQUIREMENTS- If my insurance company or third-party requires pre-certification, then 1 understand that it is my responsibility to contact them to obtain such certification. EXCEPTION: Medicare. ASSIGNMENT OF INSURANCE BENEFITS- I hereby authorize my Medicare and/or medical insurance benefits payable to me under the terms of my insurance policies to be paid directlyy to Pinnacle Health Hospitals. If my attending physician and/or other physician associated with him or whom he may designate accepts insurance assignment, then I hereby authorize my Medicare and/or medical insurance benefits to be paid directly to those physicians. I assign any and all legal rights that I have to collect benefits to Pinnacle Health Wospitals. I understand that 1 am financially responsible for non-covered services, as well as any deductibles, coinsurance or amounts in excess of insurance benefits. I permit a copy of this authorization to be used in place of the original. • GRIEVANCE APPEAL CONSENT- I hereby authorize Pinnacle Health Hospitals to act on my behalf in requesting a reconsideration of a medical determination made by my managed care plan or utilization review entity regarding my medical care. ADVANCE DIRECTIVES-INPATIENTS ONLY - I understand that Pinnacle Health Hospitals will provide me with written information regarding my rights to make health care treatment decisions in compliance with the Patient ' Self-Determination Act of 1990. This information will be provided in the Patient Handbook. MEDICARE INPATIENTS ONLY- I certify that the information given by me in applying for pa ment under Title XVIII of the Social Security 'Act is correct. I acknowledge that I have received a copy of "An Important I~pssage from Medicare". My signature acknowledges my receipt of this massage from Pinnacle Health and does not waive any of my rights to request a review or make me liable for any payment. I realize that lifetime reserve days are a once lifetime maximum of 60 days. If I si~ould use all my full days and co-insurance days, l agree to use my lifetime reserve days for any, remaining days. PRIVACY NOTICE - I acknowledge that II have received a copy of Pinnacle Health System's Privacy-Notice ~ t/ .I: linttl is .., PERSONAL VALUABLES -Pinnacle Health Hospitals is not responsible for personal items brought to the hospital. A;safe is available for valuables such as cash, important documents, credit cards and jewelry that can not be iiniti sent home: All personal items retained at the bedside are the sole responsibility of the patient. .. TELEPHONE AND TELEVISION - I understand that there Is a minimal daily charge for the availability of telephone ilocal callsConly) end television service as these services are not covered by insurance. This amount will be (init) charged tti my home telephone bill of which 1 am authorized to accept charges and allow thel release ofonly that information to the telephone company that is necessary to bill for those services. ~ ' PATIENT ANONYMITY - (Facility Directory Opt Out for Patients in the Emergency Department and Those Assigned to an In-House Bed) - I have requested Pinnacle Health Hospitals to control the knowledge of my identitY.,and presence during this course of care only. I acknowledge that the Pinnacle Health Hospital's Patient Anonymity Policy has beer- explained to me and that 1 have been provided with the guidelines. ,~. ) Signature of Petfent or Legal, Representetlve pate Signed .. ..~ "~ ' ~ CONSENT MUST BE SIGNED BY THE PATIENT'S LEGAL REPRESENTATIVE IN THE 'i' CASE OF A MINOR, OR WHEN THE PATIENT IS PHYSICALLY OR MENTA LY NCAPACITATED. . ., G~ q a~ r ~ ant or age epresentat ve ate igna . ) ~ i.. - ~ ~ ', t rintad name of Legal repreaentetlve end ~ ations ip to at ant is osprt prase, ,..~ • •' Form~iNV.9790 110/2005) MR 153 ~~P~~ r~ ~ ~ i ~ .l to sign because: ''~~ •~ ..~.. capita epreaentabve MEDICAL RECORD Form 602 Page 1 of 1 STOMAS, JAMES w-Enc #280117269-OPT-HER-11/9/2007 Facesheet - 11/9/2007 - 1 pg *****Pinnac'~ health Outpatient Facesheet~~*** Patient Name: TOMSA ,JAMES Patient No: 280117269 Nurs Sta: ~ Room/Bed: Med Rec No: 800149077 Hosp Svc: HER Admit Date: 11/09/07 Pt Status: ET Pt Type: E Areas: Patient Info: SSN: 164-64-2493 Birthdate: 12/25/1965 Age: 41 Address: 35 COLONIAL DR City:' HANOVER State: PA Zip Cd: 17331 Marital Sts: M Sex: M Phone No: 717-275-4782 Fin Class: B Religion: LUT Race: C Patient Employer Info: Empr Name: LIBERTY NISSAN Occupation: Address: CARLISLE PKE City: MECHANICSBURG State: PA Zip Cd: 17055 Phone: 717 - 737-9377 Guarantor Info: Name: TOMSA ,JAMES Patient Rel: S Address: 35 COLONIAL DR City: HANOVER State: PA Zip Cd: 17331 Phone: 717-275-4782 Guarantor Employer Info: Empr Name: LIBERTY NISSAN Address: State: Zip Cd: Emergency Contact Info: Name: TOMSA ,PAMELA Address: 35 COLONIAL DR State: PA Zip Cd: 17331 Home Phone: 717-275-4782 Insurance Information: Ins Code: B57 Priority: 1 Subscriber: TOMSA ,PAMELA Group #: 0050342600 Employer: Ins Code: Priority: Subscriber: Group #: Employer: Ins Code: Subscriber: Group #: Employer: Ins Code: Subscriber: Group #: Employer: Adm Date: Adm Dr No: Complaint: Priority: Priority: Occupation: City: Phone: - Patient Rel: Y City: HANOVER Work Phone: 717 - 541-6138 Description: CAIC POS Policy #: YWV80048478101 Precert #: Description: Policy #: Precert #: Description: Policy #: Precert #: Description: Policy #: Precert #: 11/09/07 Time: 17:10 Adm Source: OU 00193 Adm Dr Name: EMERGENCY ROOM ASSOC MVA Comments: INFO BY PT NO CARDS Resp Party: JGAUL 17:14 11/09/07 FROM P1B9,ZPPRADFI Page 1 of 1 'TOMAS,~j7AMES W-Enc #280117269-OPT-HER-11/9/2007 ED Nursing Assessment - 11/12/2007 - 4 pg ~__ I I ~ , • • i w t7 ~- u Q t- a a w 7 z a w t7 a m K a w a~ Q' Z aY a V 0. ~ i I Date: f 1 r~ S- Time: ~~ 1 ^ Harrisburg p CGOH Acuity O 1 p 2 3^ 4 ^ 5 --~^ ~r.~-a'K t S t Omg ~ Patient Name: r' r A mot' ~ A ~ _ , - ge: 1 Sex: I l Wt.(kg): Vital Signs sn- L Ventllatfon Circulation Chief Complalnt• (~I,VC. ~-LS'~cu ++tc • ciousnes i Temp: p o rt Clear ^ Pulsea ~ t'' <- ~ gp; ^R D Verbal ^ Obstructed (site) c°~'-' ~C_ L-` c ^ T ^ Labored ^ present D absent Pulse: ^ Pain N b re ~ a' 4 - ^ on-La o d ^ regular ^ irre gular Res P: ^ Unres n iv D Apneic ^ eVOng ^ weak ~~' po s e ^ Incubated k`r1GC~ ~-tir dll@iJylSS: YI'1 Su r~-~ ~~ , o~ g , G sS ~ ~e Pain Scale: D D ^ D 3 4 ^ 5 , ~ r LM P: p NIA Lactation ^ NIA ^ Y ^ N Triage Nur e: PRE-HOSPITAL CA RE UNIT: Mode of Arrival: Patient Disposition: D Rm# ^ Waitin Room ^ BLS ^ ALS A i d kh d Ab S Ad lUChild Vital Signs gp: p; R: rr ve w : usoec e use: u q'} $~} , g ~Z 4 Wheelchair ^ No Identified Needs . 1 ^ Ambulato ~ Unusual/susp(cious marks Loss of 0 ^ YES ry ^ Speaks No English Carried D Sexual Abuse Consciousne a Lan ua e: g 9 O Domestic Violence Airway ^ Oral ^ Nasal ^ET TUBE Translation By: D Safe Referral ~ Size: IMMUNIZATIONS Oxygen TETANUS: PSH! Social D Suicide Risk u se ox: gen hl d 00 Plan: Heart Rhythm: O UTD D Not UTD CPR St d g a e : Triage Protocols/ AED Interventions: Medications IV Therapy Gauge Slte Solution t I(t. e N O-~A- O k i M / dl - ~ extrost c Medications Administered Pre-hospital Signature of Provid er. Triage /Primary Nurse : Time: VENTILATION NEURO ^ALERT ^ ORIENTED pAIN ^ DENIE3 O NA OU ODENIES ^NA NURSING. DIAGNOSIS ^ SYMMETRICAL & UNLABORED ^ CLEAR ^ DISORIENTED AREA: ^ RETENTION ^ INEFFECTIVE;AIRWAY CLEARANCE ^ LABORED ^ GLASGOW COMASCALE Oudity: ^ DYSURIA ^FOLEY ^ INEFFECTIVE BREATHING PATTER ^ VJHEE2ING OL O A ^ RALES/RHONCHI O L O R ^ HEADACHE Redle9on: SEVERITY (none-severe) ^ IMPAIRED OAS EXCHANGE ^ DIMINISHED O L OR ^ STIFF NECK Q ~ T 3 4 5 GYN ^DEN1E5 ^ NA ^ FLUID VOLUME DEFICIT ^ RETRACTIONS ODITZINESS Tlme: ^ VAGINAL BLEEDING ^ALT. BOGY TEMP GRCULATION EMOTIONAL ^ COOPERATIVE ^NORMAL FLOW ^ABNORMALFLOW ^ALT.TISSUEPERFUSION ^ PULSES (site:) ^ UNCOOPERATIVE GI ^DEN E ^ .^ PERIPHERAL / CMDIAC /CEREBRAL ^PRESEN7 Q ABSENT ^ STRONG ^ VuEAK ^ANXIOUS ^ FLATAFFECT I NA 5 ^ NAUSEA ^ VOMITING ^ DISCHARGE: ^ IMPAIRED SKIN INTEGRITY ^ REGULAR ^ IRREGULAR ^AVOID3 EYE CONTACT ^DWRRHEA ^CONSTIPATIDN EENT []DENIES ^ NA OPAI N: ACUTE /CHRONIC ^ IMPAIRED MOBILITY ^ EDEMA: ^ BABY DDARKSTOOLS VISUAL ACUITY: ^ JVD TRAUMA ^ CORRECTED ^ INEFFECTNE COPING ^ CAPILLARY REFILL: ^ ABRASION: ^ ABDOMEN ^ NA ONOT CORRECTED ^ OTHER: ^ <2 SEC ^ >2 SEC ^LACERATION: ^ SOFT ^FIRM OU: SHIN ^ ECCHYMOSI3: ^ DISTENDED OD: ^ PINK ^ PALE ^ DRY ^ DIAPHORETIC ^ DEFORMnY: ^ TENDER: ^ BOWEL SOUNDS: OS: ^ EPISTAXIS ^ R O L ^ CYANOTIC ^ JAUNDICE ^ BURN ^SEE ODY DIAGRAM ( N B ) ^PRESEN7 QABSENT ^ EARACHE ^ R ^ L ^ SORETHROAT PRIMARY NURSE SIGNATURE: / \ '~/~ .,, ~/ 1 _, TIME: ~~ PINNACLEHEALTH EMERGENCY NURSING Hospirals ASSESSMENT SHEET i ll I I Form INV 7482 (09107) MR In0 Page 1 of 4 ED2505 PATIENT INFORMATION IiII~l~11N{11~1~~I~lal{Illhli1ti81{1~1~~ MR: 800149077 CASE: 280117269 TOMSA ,JAMES M DATE: 11/09!07 DOB:12/25l1965 Ph#: 717 275-4782 AGE: 41 DR: SSN: 164842493 •TOMAS,',JAMES W-Enc #280117269-OPT-HER-11/9/2007 ED Nursing Assessment - 11/12/2007 - 4 pg - ~ ._ I • LJ V RIGHT RIGHT LEFT ANTERIOR POSTERIOR ~-~_ ~'~ ~~ ~~ (® n GLASGOW COMA SCALE BODY SITE INJURIES CODE p NA A. ABRASION AV. AVULSION B-BURN C -CONTUSION D -DEFORMITY L -LACERATION P-PUNCTURE SW -STAB WOUND S - SWELL4NG AMP -AMPUTATION EYE OPEN BEST MOTOR RESP. BEST VERBAL RESP. 4 -SPONTANEOUS g • OBEYS COMMAND 5 -ORIENTED 3 • TO SPEECH 5 - LOCALIZE$ PAIN 4 -CONFUSED 2 -TO PAIN 4 -1MTHDRAINS 3 •1NAPP WORDS t • NONE 3 •ABN FLEXION 2 - INCOMP SOUNDS 2 •ABN EXTENSION 1 • NONE 1-NONE PUPIL SIZE ~ ~' R-REACTIVE S -SLUGGISH N - NONREACTIVE 1 2 3 4 6 6 7 8 B LEFT HAND _ ~ , ~~11~J ANTERIOR POSTERIOR RIGHT HAND _ ° z 1 ~ / I `11.~ ~ ~~ ANTERIOR POSTERIOR • Patient Name: • ~ Patient S.S.#: ~ I r Page 2 of 4 ~I'OMAS,'JAMES W-Enc #280117269-OPT-HER-11/9/2007 ED Nursing Assessment - 11/12/2007 - 4 pg r, ~_ a r~ L J • Paae of ' Procedures Medications ^ ECG: ^ Labs: ^ UA: DATElT1ME ORUG DOSE ROUTE SITE INIT ^ X-Ray: ^ BCx2 BCi: BC2: ^ CT. ^ UIS: ^ ABG: IV Sotuttons DATE/T1ME SITE SIZE SOLUTIONNOLUME RATE INIT DateR-ime BP P R SpOz os PA IN NARRATIVE 1GS°i 0 1 2 3 4 5 Q' ~ S i~ 0 1 2 3 4 5 i i 1' ~ 0 1 2 3 a VIU S i'L- +:~'1tr • ~ Y i' , 'pr r cL fn, - 0 1 2 3 4 5 ~ 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 Admitted sp sltion Assessment nl Si stare ^ Admit ^ 23°hr OBS Attendin : Time: B/P: P: R:_ Pa' 0 2 3 4 5 SpOz: g gem; _ arged ^ ransferred Report called by: (~e~:ansfer form) JJ To: Time: To Bed: Monito In the care of ^ !Family verbalized understanding of ^ Yes ^ No / I tractions Mode: p W!C ^ S I tru ins given by: tretcher Advanced Directives Discussed ^ ode: O Ambulatory ^ WIC ^ Helicopte Copy availabie ^ ^ EMS ^ Carried p Crutches RN RN • EMERGENCY NURSING PINNACLEHEALTH FLOW SHEET • Hospitals CONTINUATION ~~ yy `` I iIE~ `` }} 1~1~ ~~ ~~ fii 111111111111 Form WV T4B3 (D9/07} MR ED2505 (InD) I Il{11 NI11 VIII !~fl I~fl I~II.111111111111~ 11111111 MR: 800149077 CASE: 280117269 TOMSA ,JAMES •• M DATE: 1 1 /09/07 DOB: 12/25!1965 Ph#: 717 275-4782' AGE: at DR: SSN:164642493 F Paye 3 of 4 ~I'OMAS,~JAMES W-Enc #2F30117269-OPT-HER-11/9/2007 ED Nursing Assessment - 11/12/2007 - 4 pg ' /-~ ( ~ i Urinalysis. Reference Ranges: Protein Negative Glucose Negative Bilirubin Negative Ketones Negative Blood Negative Nitrates Negative Leukocytes ~ Negative Urobilinogeri Normal PH - - .. ~;.._ _ 5.0-8.0 Specific Gcavity '5.403-1..034 Blood Glucose Monitor • Reference Range: 74-118 mg/dL .Troponin I Reference Range <0.03 ng/mL - 0.49 ng/mL ~ • •' r 1 U Page 4 of 4 ~TOMAS,~,JAMES w-Enc #28011726~91)-OPT-HER-11/9/2007 ED Patient Instruction Sheet - 11/12/2007 - 1 pg i • ' ~i...J Y, • 44f II't.Y. MIh I .M !Y~~~~i'!~'f ~ ~ : ~-1~ r i I I~r•~ 1 '11dU' r ~ i.b, • w1 l 1 UI Iri4 f', 1.1 ., ~ a~ ~; , ~,~ CGOH EO 657-7295 • ~Fiarrisburg ED 782-5257 Plt:~si~ note that the instructions circled or checked be w pertain to yo u have been discharged with the diagnosis of ~`~ ~ ~l/~ •7he examination and treatment you have received in the Emergency Department have been rendered on an emergency basis, and not intended to be a substitute for ongoing care provided by a primary care physician or specialist. Not all of your medical problems may be known, diagnosed and/or treated at this visit. It is important for you to follow up with your physician and to return to the Emergency Department if you become worse in anyway. General Instructions Supp{emental Instruction Sheet ^ Yes Rest for Off work /school from to ^ Medication(s) Retum to work on Light duty for Regular duty f ~s -•C.1 Mlsc Ilaneous 'vv~~n-' o Care: Retum to the Emergency Department immediately if i'iG~~ ! ~~ unexpectedly worse or not improved. Emergency Departure t og~ ~, Caution -Medications may Cause drowsiness. ~~Family Physician ~~~_ _ ``~~4. See Dr. on at AM 1 PM. Call the following clinic within one business day for an appointment to be seen in _day(s): -Hamilton Health Center, 1821 Fulton Street 232-9971 Community Health Center: ' Children 8 Teen Center, 2nd FI 782-4650 _ Women's Outpatient, 3rd FI 782-4700 Kline Health Center, Landis Bldg. 2nd Floor: -Adult Outpatient Clinic 782-6421 _ Orthopedic Cllnlc 782-2142 .~^ Surgical Clinic 782-6421 _ Kline Fami{y Practice Center 782-2100 6. If you smoke you are advised to stop.Please call 717-221-6250 or access www.oinnaclehealth.oro for more Informatlon on smoking X-Ray Instructions I ti. Biology Studies -Including plain 'fit ys, CT/MRI Scans and trasounds. Your Radiology Studies) have been reviewed by an Emergency Physician, Physician's A~sistant or Radiologist. P~ final Radiologist's interpretation yy~v~II be reported and you or your tlpctor will be notified of any % 1 )?normalities which reyulre PINNACLEHFALTH Hospitals - No alcoholic bevereges. - Do nat drive, operate machines, or perform risk taking activities. I hereby acknowledge receipt of these instructions, I will arrange for follow-up care as I have been Instructed. will take the medication list to my physician,_ X /,~,, _ 5 gna'ture F Patent or Reaponsi arson Date R.N. Signature ~ yslQinn'Signattire C--------'.-----------~:. ------ Data ^~ ~/ ~ ~ PINNACLEHEALTH Hospitals I Emergency Department Harrisburg - 782-5257 CGOH = 657-7295 P.O. Box 8700 Harrisburg, PA 17105'-8700 ~i µ/. ' Substitution Permissible i~~ ~~ ,•M:D:;>D.O. wy ~ IN ORDER FOR A BRAND NAME PRODUCT TO BE DISPENSED, THE PRESCRIBER MUST WRITE 'BRAND NECESSARY' OR'aRAND MEDICALLY NECESSARY' IN THIS SPACE Emergency Department MAY REFILL ~ TIMES Patient Instruction Sheet PA u~u DEANo. //,/~' rJ'C ~~~~~~~ I I V III VI II III III II III NII II l i I l «f ~~~ PRINT PHYSICIAN NAME LABEL ALL PRESCRIPTIONS' ED2507 Earn ;prv I9(x)1 (07!07) MR Flat pppy - patient (PM) Sacond copy -Medical Racorda PATIENT INFORMATION I Illy ll~ IuK l~~ 1111 111 ~ l~{ lull I1N ~~ MR: 800149077 CASE: 280117269 M TOMSA ,JAMES DATE: 11/09/07 D013:12125/1966 Phli: 717 275-4782 AGE: 41 DR: 5SN:164642493 `~ .,~ • Page 1 of 1 TOMAS, JAMES W-Enc #280117269-OPT-HER-11/9/2007 ED Physician Orders - 11!12/2007 - 1 pg `_ Date Time ' Procedures Supplies OCardiac Monitor DECG ^Nasogastric tube ^Foley Catheter ^Straight Catheter ^IV: ^Oz LPM~ ^Pulse Oximetry ^Non-invasive COHbg ^Peak Flow ^Neb Treatment: a Allergies: Lab Time: Initials: Dru Levels Cultures ^ ABG D Glucose ^ Acetaminophen ^ Blood x O Acetone ^ Hepatic Panel ^ Aspirin ^Chlamydia ^ Amylase ^ H&H O Carbamazepine ^ GC ^ ALT/AST ^ Lactic Acid ^ Oigoxin ^ GC/Chlamydia ^ Ammonia ^ Lipase ^ Lithium (ene amp) ^ BMP ^ Magnesium p Phenobarbital ^ ~erpes ^ Cardiac ^ Myoglobin ^ Phen oin ^ Sputum p BNP ^ PT/INR ^ Theophylline ^ Stool D CK -Total ^ PTT p Urine Tox. ^ Stooi - C-dill D CK - MB ^ Qual HCG ^ Valproic acid ^ Throatlstrep D CK -Index ^ Quant HCG ^ Urine ^ Troponin I ^ Rpt Cardiac Blood Bank p CBC w/auto dill ^ CK -Total D Type 8~ Cross D Wound: O COHbg ^ CK - MB D Type & Screen ^ Comp Met Panel ^ CK -Index ^ Rh Factor D CRP ^ 0-Oimer (DVT) ^ Troponin I ^ TSH Bedside Testing ^ Electrolytes O Sed rate ^ gGM D ETOH D Urinalysis ^ CG4+ ^ Chem 8+ Radiology Time Initials: < any Portable: OC-spine DCXR OPelvis Spine:^ C ^ T ^ US ^ Ankle L R ^ CXR ^ Elbow L R ^ Faciai ^ Femur L R D Finger L R ^ Foot L R D Forearm R ^ Hip ^ PT/INR ^ Humerus ^ Qual HCG (urine) O Nasal ^ Troponin I ^ Knee ^ KUB If ST Elevation MI ^ Thrombolysls (Order sheet) ^ Ob Series ^ STAT Cardiology Consult with (PreCath orders) ^ Pelvis AMI ASA 325 mg po ^STAT, ^ Given PreHospital, D Taken at Home ^ Ribs Orders Beta 8locker D Metoprolol rmg IV q_ minutes X 3 (do not give if BP< and/or HR<~. ^ Shoulder ^ Metoprolol _mg po ^ Carvedllol mg po (if EF anticipated to be under 40%) D Skull Diuretic: ^ Furosemide mg IVP, ^ Bumetanide mg IVP D Tib/Fib CHF !f urine output <200mL within 30 minutes considerredosing ^ WriSt Orders IV Vasodllating Agent: $ m om~ ^ Nitroglycerin mcg/min IV ~, __ ~ ~R R L R L R L R L R L R L R Acute ^ Vital Signs q 15 minutes ^ IV: 0.9 NSS Q 50 mllhour D BGM ^ Stroke Alert Team ' CVA ^ Labelalol mg IV ^ Nlcardiplne mg IV called @ Tlme: ^ US: Drders Date Time Additional Orders: ^ Venous Doppler: ~ ^ MRI: ^ V-Q Scan ^ Other: ^ Send copy of final radiology report to Dr. Physician's signature: a~ PiNNACLEHEALTH Hospitals • EMERGENCY DEPARTMENT PHYSICIAN'S ORDERS Form INV 70747 (08/07) MR E02502 (InD) Formerly 0742-20 MR: 800149077 CASE: 280117269 TOMSA ,JAMES M DATE: 11/09/07 DOB: 12/26/1965 Ph~J: 717 275-4782 AGE: 41 3 DR: SSN:164642493 Page 1 of 1 Y'OMAS, JAMES w-Enc #280117269-OPT-HER-11/9/2007 ED Report - 11/13/2007 - 1 pg ACCT#=00280117269 T(~VSCRIBED DATE=11/13/2007 0~~ 3 UDN= 2248224 TOM S. ._ JAMES W RM#. MRN: 800-14-9077 CASE: 00280117269 DOB: 12/25/1965 ADM: 11/09/2007 PinnacleHealth System P.O. Box 8700 Harrisburg, PA 17105-8700 EMERGENCY DEPARTMENT CHIEF COMPLAINT: MVA. HISTORY OF PRESENT ILLNESS: A 41-year-old male presents to the Emergency Department completely immobilized in C-collar and board. MVA, was the restrained driver of a vehicle rear-ended, bumped into an other vehicle. No LOC. Not self extricated. He complaining of neck pain, 3-4/5, kind of achy and dull. No neurological symptoms. REVIEW OF SYSTEMS: Negative except for those presented in HPI. PAST HISTORY: ALLERGIES: NO KNOWN DRUG ALLERGIES. Medications: None. Medical history: Knee surgery, right arm surgery, gastric bypass. SOCIAL HISTORY: Negative tobacco. No drugs or alcohol. :Lives with his family. PHYSICAL EXAMINATION: Vital signs: Reviewed. Constitutional: Mild distress. Mental status/Psychiatric: Judgment and insight appropriate for age. Oriented to time, place and person. No recent memory loss. Affect appropriate for age. Eyes: Pupils equal and reactive to light. No exudates. EDIT: Oropharynx clean, mucous membranes moist. Ears and nose without masses, lesions or deformities. Head/neck: Positive tenderness over the paravertebral muscles in his C-spine. Respiratory: Clear to auscultation and percussion. Cardiovascular: No murmurs or gallops. Heart sounds normal. Gastrointestinal: No masses or tenderness. No hepatosplenomegaly. Integumentary: No rashes, lesions. Good turgor, no edema. Neurological: Deep tendon reflexes symmetric. Babinski negative. Sensation intact bilaterally. Musculoskeletal/Joint: Capable. of free range of motion without pain, crepitation. No effusion or erythema. Lymphatic: Palpation, neck - No swelling or tenderness of neck nodes. Palpation groin - No swelling or tenderness of groin nodes. EMERGENCY DEPARTMENT PHYSICIAN TEST INTERPRETATION: A left hand x-ray and C-spire CT were ordered. Interpretation - CT of the C-spine was negative. X-ray of the hand was negative. EMERGENCY DEPARTMENT COURSE: Patient removed from the board, but kept on the C-spine immobilization with the Philadelphia. collar. Patient has remained stable. DISPOSITION: Discharging him on Flexeril 10 mg one tab PO t.i.d. p.r.n. Do not drink, drive or operate heavy machinery or take risk taking activities while on this medication, 15 tablets. Warm, moist heat to the effected area as tolerated. Return if any worsening. Follow up with family doctor this week. Page 1 of 2 TOMAS,' JAMES W-Enc #280117269-OPT-HER-11/9/2007 ED Report - 11/13/2007 - 1 pg DIAGNOSTIC IMPRESSION: C-~ ~.ne strain, left hand contl' or.~ status post MVA. C: HBG ED BILLING DEPT Signed by CAICEDO MD, CHRISTIAN on 30-Nov-2007 21:20:47 -0400 --------------------------- CHRISTIAN CAICEDO, MD Patient: TOMSA, JAMES W DD: 11/09/2007 DT: 11/13/2007 /klb D#: 2248224 ER REPORT ER REPORT Paye 2 of 2 ER REPORT TOMAS„DAMES W-Enc #280117269-OPT-HER-11/9/2007 Radiology Report - HAND MIN 3V LEFT - 11/9/2007 - 1 pg ' ~ ~ ~ ~~- ~INN,ACLEHEALTH System Radiology Imaging Report MR#: 800149077 SSN: 164642493 ADM: 000280117269 DOB: 12/25/1965 AGE:41Y BED: - PTCLASS: E REASON: Trauma NAME: TOMSA, JAMES 35 COLONIAL DR HANOVER, PA 17331 ORD DR: CAICEDO, CHRISTIAN H ORD#: 90001 ATT DR: EMERGENCY ROOM, ASSOCIATES PCP: UNKNOWN, DR COMMENTS: er hall 1 ***Final Report*** HARRISBURG DIAGNOSTIC DEPARTMENT PROCEDURE: DIA - 4566 -HAND MIN 3V LEFT PROCEDURE DATE: Nov 9 2007 6:14PM ACCESSION#: 5780068 Exam: Left hand, 3 views History: History of recent trauma. Result: Routine views of the left hand were obtained. There are no prior studies for comparison. Bone mineralization is normal. There are no acute fractures or dislocations. There is a small bone island noted in the head of the third metacarpal. The joint spaces are well maintained. No significant soft tissue abnormalities are visualized. Impression: No acute abnormality. DICTATED: (11/10/2007 12:00) TRANS: (PSC/PS) ON: 11/10/2007 12:05 INTERPRETED AND REVIEWED BY: RICHARD P MOSER, JR., MC, FACR ELECTRONICALLY SIGNED: 11/10/2007 12:05 To provide the best and safest patient care: During routine daytime weekday, weekend, and holiday on-site coverage, a Radiologist can be contacted at 782-5881 (HH), 657-7199 (CGOH), or 791-2451 (Fredricksen Center). Alternatively a Quantum Radiologist can be reached by phone 24 x 7 x 365 at 932-8030. As Clinicians' consultants, the Quantum Radiologists are genuinely committed to providing meaningful interpretations. Accordingly, if the clinical team is in search of answers to specific questions, please include your questions(s) on the xray request form, and the question(s) will be specifically addressed in the Radiologist's report. Furthermore, if clinical urgency necessitates an immediate verbal report, please insure that the xray request includes a reliable phone number where you can be reached immediately. Study interpretation provided by QUaIltUR7 /Ill8gfllg & Therapeutic ASSOC%31ES. If you have received this document by facsimile, the information contained in this transmission is privileged and confidential. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately at: 1-717-782-32411. Printed: November 10, 2007 12:06 PM Page 1 of ] 'TOMAS,~•JAMES W-Enc #280117269-OPT-HER-11/9/2007 Radiology Report - CT CERVICAL W/O CONTRAST - 11/9/2007 y `~ ~PlNM.ACLEHEALTH System Radiology Imaging Report M R#: 800149077 SS N : 164642493 ADM: 000280117269 DOB: 12/25/1965 AGE:41Y BED: - PTCLAS S: E REASON: Trauma NAME; TOMSA, JAMES 35 COLONIAL DR HANOVER, PA 17331 ORD DR: CAICEDO, CHRISTIAN H ORD#: 90002 ATT DR: EMERGENCY ROOM, ASSOCIATES PCP: UNKNOWN, DR COMMENTS: er hall 1 ***Final Report*** HARRISBURG CT DEPARTMENT PROCEDURE: CTS - 4578 - CT CERVICAL W/O CONTRAST PROCEDURE DATE: Nov 9 2007 5:57PM ACCESSION#: 5780069 Exam: CT cervical spine unenhanced with reformations. History: MVA, restrained driver. Back pain. Result: There are no prior exams for comparison. Axial CT images were obtained through the cervical spine without IV contrast and reformatted in the corona/ and sagittal planes. There is straightening of the upper cervical spine which may be related to positioning or muscle spasm. Vertebral body heights are maintained. There is mild disc space narrowing at C6-C7 with associated endplate hypertrophic changes. There is mild uncovertebral joint hypertrophy throughout the mid. to lower cervical spine. There is no fracture identified. Postsurgical changes are noted at the maxilla with mucoperiosteal thickening involving the inferior right maxillary sinus. Impression: Degenerative changes without evidence of acute abnormality. Straightening of the cervical spine is noted either related to positioning or muscle spasm. DICTATED: (11/09/2007 18:45) TRANS: (RG&/PS) ON: 11/09/2007 19:00 INTERPRETED AND REVIEWED BY: DOUGLAS J MARTIN,MD ELECTRONICALLY SIGNED: 11d09l2007 19:00 To provide the best and safest patient care: During routine daytime weekday, weekend, and holiday on-site coverage, a Radiologist can be contacted at 782-5881 (HH), 657-7199 (CGOH), or 791-2451 (Fredricksen Center). Alternatively a Quantum Radiologist can be reached Eby phone 24.x 7 x 365 at 932-8030. As Clinicians' consultants, the Quantum Radiologists are genuinely committed to providing meaningful interpretations. Accordingly, if the clinical team is in search of answers to specific questions, please include your questions(s) on the xray request form, and the question(s) will be specifically addressed in the Radiologist's report. Furthermore, if clinical urgency necessitates an immediate verbal report, please insure that the xray request includes a reliable phone number where you can be reached immediately. Study interpretation provided by QUaf7tllr17 %mag%ng & ThBI-ap@UfIC ASSOC/BfeS. If you have received this document by facsimile, the information contained in this transmission is privileged and confidential. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately at: 1-717-782-3240. Printed: November 9, 2007 7:01 PM Page 1 of 1 EXH/BI T "D" r_ Hillside Pain Management, P.C. Terrence M. Calder, M.D. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN SCHWARTZ M D PCP: Referring Doctor: John Schwartz M D Primary Physician: Dr J. Schwartz MD Other physicians or providers involved with care: ,, Debra A. DeAngelo, D.O. CHIEF COMPLAINT James Tomsa Sr is a 42 year old new patient seen in the office today. The patient presents with lumbar pain. The following.fonms were reviewed with the patient and scanned into the chart: New Patient Questionnaire, Pain Diagram. Outside records were received. Reports were reviewed and scanned into the chart: MRI Report. HISTORY OF PRESENT ILLNESS: 4/1/08 New Consult :Patient involved in MVA 11/07, he was sitting on an exit ramp. He was'hit from behind and pushed into the vehicle in front of him. He was a belted driver. He was treated with muscle relaxants and narcotics by his PCP till they are no longer giving him relief. His pain is bilateral low back radiating into his bilateral posterior legs into his lower legs. He does note most recently his pain is radiating into his feet. He describes his pain as: deep, numb, stinging, unbearable, burning, throbbing, band like, heavy, sharp, knife like, shooting. Increases his pain: bending over, twisting, walking. Decreases pain: relaxation. His pain does waken his at night and he does not easily return to sleep. Pain levels are baseline. Best pain (out of 10):2 Worst pain (out of 10): ] 0 Current pain (out of 1.0):5 SOCIAL HISTORY: ALCOHOL: Moderate alcohol consumption. TOBACCO USE: Has no smoking history. MARITAL STATUS: Separated. OCCUPATION: Sales. CAFFEINE: Does not use caffeinated beverages. IL.LICI.T DRUG USE: No history of illicit drug use or prescription misuse. PAST MEDICAL HISTORY: .MEDICAL: Arthritis. SURGICAL: Right knee arthroscopy, left knee arthroscopy. right arm reconstruction surgery (hunting accident) gastric bypass. PRIOR PAIN TREATMENTS: Pain medication: muscle relaxants, narcotics. Physical modalities: none. Injection therapy: none. percocet, vicodin -made him very sick, skelaxin PatientID: AU14797 Page I of .5 ~. Hillside Pain Management, P.C. Terrence M. Calder, M.D. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN SCHWARTZ M D PCP: Debra A. DeAngelo, D.O. GENERAL FAMILY ILLNESS: .Positive family history of diabetes, positive history of hypertension, positive history of cerebrovascular accident, positive history of myocardial infarction. Medical history, allergies and current medications were reviewed with the patient ALLERGIES: PERCOCET Adverse Reaction: NAUSEOUSNESS AND VOMITING. VICODIN Adverse Reaction: NAUSEOUSNESS AND VOMITING. CURRENT ALLERGY LIST: PERCOCET VICODIN 1VLEDICATIONS: SKELAXIN ORAL TABLET 800 MG, qid, status: NEW HISTORY, 04/01/2008. VITAMIN C ORAL TABLET 1000 MG, qd, status: NEW HISTORY, 04/01/2008. MULTIVITAMIN/IRON ORAL TABLET, 1 Every Day, status: NEW HISTORY, 04/01/2008. Is patient taking blood thinning med? CURRENT MEDICATION LIST: SKELAXIN ORAL TABLET 800 MG, qid VITAMIN C ORAL TABLET 1000 MG, qd MULTIVITAMIN/IRON ORAL TABLET, 1 Every Day REVIEW OF SYSTEMS: Patient denies all symptoms in all systems except as noted. GENERAL: Intermittent chills. EARS/NOSE/MOUTH/ THROAT: Has nasal congestion. RESPIRATORY: Has a cough. MUSCULOSKELETAL: Back pain, joint pain. VITAL SLGNS: VS-TEMPERATURE: 96°f Tympanic VS-PULSE: 78 Apical, Regular VS-BLOOD PRESSURE: 131/95 Right Ann Sitting V S-RESPIRATION: 18 PatientlD: AU14797 Page 2 of 5 1 \ ~..._ Hillside Pain Management, P.C. Terrence M. Calder, M.D. Debra A. DeAngelo, D.O. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN SCHWARTZ M D PCP: V S-HEIGHT: Eft VS-PULSE OXI.METRY: 95% VS-WEIGHT: 2651bs Patient received the following educational handouts: Lumbar epidural injectionYes .Documentation gathered by: Gloria Hahn. PHYSICAL EXAM: GENERAL APPEARANCE: Overweight body habitus. In mild to moderate distress. PAIN.BEHAVIORS: Behaviors are within expected context of disease. MUSCULOSKELETAL EXAM: SPINE, .RIBS, PELVIS: No erythema, ecchymosis, or edema. No tenderness. No kyphosis, lordosis, or scoliosis. CNs II-XII grossly intact. SENSATION: PERIPHERAL NERVES: Sensation to touch and pressure intact. REFLEXES: 1+/4+ patellar bilaterally. SPECIAL TESTS: Straight leg was positive bilaterally. GENERAL EXAM: ORIENTATION/MOOD/AFFECT: Oriented to person, place, time and general circumstances. Mood and affect appropriate. RESPIRATORY: Normal respiratory effort with symmetrical lung expansion. Lungs clear to auscultation. No adventitious sounds noted. CARDIOVASCULAR: PALPATION & AUSCULTATION: Regular rate and rhythm with no murmurs, gallops, nibs or abnormal heart sounds. IMAGING STUDIES: LUMBOSACRAL: LUMBAR MRI: MRI OF THE LUMBAR SPINE WITHOUT CONTRAST: 3/1212008 Sagittal and axial T1 and T2 weighted images of the lumbar spine are obtained without intravenous administration of contrast material. Correlation is made without the plain film study done on 2/29/2008. There is normal alignment and curvature of the lumbar spine. The vertebral bodies are of normal height and PatientlD: AU14797 Page 3 of 5 ~ _ Hillside Pain Management, P.C. Terrence M. Calder, M.D. Debra A. DeAngelo, D.O. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN SCHWARTZ M D PCP: signal intensity. There is no evidence of bone marrow edema or infiltration. No fracture is identified. There is decreased signal intensity of the intravertebral discs at the level of L4-LS and LS-S 1 with moderate to severe narrowing of the intravertebral disc space at the level of LS-S 1. The conus medullaris is of normal signal intensity and tapers at the level of L1-L2. There is no paravertebral soft tissue abnormality. Questionable cysts at the right kidney. At the level of L2-L3, there is no focal disc protrusion, spinal canal or neural foraminal stenosis. The ligamentum flavum and facet joints are not hypertrophied. At the level of L3-L4, there is broad-based disc bulging indenting the thecal sac without significant spinal canal or neural foraminal stenosis. The ligamentum flavum and facet joints are not hypertrophied. At the level of L4- L5, there is the presence of an anular tear seen clearly on the sagittal views. There is also mild central disc bulging causing mild spinal canal stenosis. There is mild to moderate ligamentum flavum and facet joint hypertrophy causing mild bilateral neural foraminal stenosis. There is presence of bilateral capsular synovitis. At the level of LS-S1, there is broad-based disc bulging indenting the thecal sac without significant spinal canal or neural foraminal stenosis. IMPRESSION: 1. Disc desiccation at the level of L4-LS and LS-S 1 with moderate to severe narrowing of the intravertebral disc space at the level of LS-S1 confirming the plain film finding. 2. Broad-based disc bulging at the level of L3-L4 indenting the thecal sac without significant spinal canal or neural foraminal stenosis. 3. Disco-osteophytic changes at the level of L4-LS with presence of anular tear seen on the sagittal images. There is mild spinal canal stenosis and minimal bilateral neural foraminal stenosis. 4. Broad-based disc bulging at the level of LS-S 1 indenting the thecal sac without significant spinal canal or neural foraminal stenosis. 5. Probable right renal cyst. Physician HPI Comments: S/P MVA with gradually worsening back pain with radicular symptoms. PatientID: AU14797 Page 4 of 5 Hillside Pain Management, P.C. Terrence M. Calder, M.D. Patient was seen by: TERRENCE CALDER MD Debra A. DeAngelo, D.O. Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN SCHWARTZ M D PCP: AS SESSMENT/PLAN 724.4-RADICULAR LOW BACK PAIN, THORACIC/L,UMBAR 722.10-DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT Assessment: radicular symptoms with bulging disc at several levels, but clinically most likely caused by LS-S 1 Plan: schedule for LS-S 1 TL Electronically Signed by: Gloria Hahn, LPN on Tuesday, Apri101, 2008 Electronically Signed by: Terrence Cnlder, M D on Tuesday, April O1, 2008 PatientID: AU14797 Page 5 of 5 York Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Debra A. DeAngelo, D.O. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN R SCHWARTZ M D PCP: Referring Doctor: John Schwartz M D Primary Physician: Dr J. Schwartz MD Other physicians or providers involved with care: CHIEF COMPLAINT James Tomsa Sr is a 42 year old new patient seen in the office today. The patient is scheduled for Procedure. HISTORY OF PRESENT ILLNESS 4/1/08 New Consult :Patient involved in MVA 11/07, he was sitting on an exit ramp. He was hit from behind and pushed into the vehicle in front of him. He was a belted driver. He was treated with muscle relaxants and narcotics by his PCP till they are no longer giving him relief. His pain is bilateral low back radiating into his bilateral posterior legs into his lower legs. He does note most recently his pain is radiating into his feet. He describes his pain as: deep, numb, stinging, unbearable, burning, throbbing, band like, heavy, sharp, knife like, shooting. Increases his pain: bending over, twisting, walking. Decreases .pain: relaxation. His pain does waken his at night and he does not easily return to sleep. 4/1/08 Procedure Visit: patient has read and signed his procedure consent Best pain (out of 10):5 Worst pain (out of 10):10 Current pain (out of 10):5 PAST MEDICAL HISTORY: MEDICAL: Arthritis. SURGICAL: Right knee arthroscopy, left knee arthroscopy. right arm reconstruction surgery (hunting accident) gastric bypass. PRIOR .PAIN TREATMENTS: Pain medication: muscle relaxants, narcotics. Physical modalities: none..lnjection therapy: none. percocet, vicodin -made him very sick, skelaxin PatientID: AU14797 (- York Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN R SCHWARTZ M D PCP: Medical history, allergies and current medications were reviewed with the patient CURRENT ALLERGY LLST: PERCOCET VICODIN Is patient taking blood thinning med?no CURRENT MEDICATION LIST: SKELAXIN ORAL TABLET 800 MG, qid VITAMIN C ORAL TABLET 1000 MG, qd MULTIVITAMIN/IRON ORAL TABLET, 1 Every Day VI.TA.L SIGNS: VS-TEMPERATURE: 97.5°f Oral VS-PULSE: 78 Apical, Regular VS-BLOOD PRESSURE: 140/96 Right Arm Sitting VS-RESPIRATION: 18 VS-PULSE OXIMETRY: 98% Documentation gathered by: Gloria Hahn. PHYSICAL EXAM: Debra A. DeAngelo, D.O. GENERAL APPEARANCE: Overweight body habittis. In mild to moderate distress. PAIN BEHAVIORS: Behaviors are within expected context of disease. MUSCULOSKELETAL EXAM: SPINE, RIBS, PELVIS: No erythema, ecchymosis, or edema. No tenderness. No kyphosis, lordosis, or PatientlD: AU14797 ~ _. Page 2 of 4 (~ ~~~ .. York Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Debra A. DeAngelo, D.O. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN R SCHWARTZ M D PCP: scoliosis. CNs II-XII grossly intact. SENSATION: PERIPHERAL NERVES: Sensation to touch and pressure intact. REFLEXES: 1+/4+ patellar bilaterally. SPECIAL TESTS: Straight leg was positive bilaterally. GENERAL EXAM: ORIENTATION/MOOD/AFFECT: Oriented to person, place, time and general circumstances. Mood and affect appropriate. RESPIItATORY: Normal respiratory effort with symmetrical lung expansion. Lungs clear to auscultation. No adventitious sounds noted. CARDIOVASCULAR: PALPATION & AUSCULTATION: Regular rate and rhythm with no murmurs, gallops, rubs or abnormal heart sounds. ASA I Physician HPI Comments:S/P MVA with gradually worsening back pain with radicular symptoms. ASSESSMENT/PLAN: 724.4-RADICULAR .LOW BACK PAIN, THORACIC/LU.MBAR 722.10-DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT Assessment: radicular symptoms with bulging disc at several levels, but clinically most likely caused by LS-S 1. Plan: schedule for LS-S 1 TL PatientID: AU14797 Page 3 of 4 (_ York-Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Debra A. DeAngelo, D.O. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/01/2008 Referred from: JOHN R SCHWARTZ M D PCP: Procedure: Translaminar (Interlaminar) Epidural. Procedure performed by Dr. Terrence Calder. Preoperative Diagnosis: radicular low back pain (724.4), herniated lumbar disc (722.10). Postoperative Diagnosis is the same. Procedure Note: The patient was taken to the procedure room and placed in a prone position. Their back was sterilely prepped with betadine. L 5-S 1 was identified with fluoroscopy, and the C-arm was adjusted to maximize the interlaminar space. The skin was anesthetized with 1% Lidocaine and a 22 gauge tuohy needle was advanced with fluoroscopic guidance using loss of resistance technique via a paramedian approach. There was no CSF, heme or paresthesias. When the epidural space was located, placement was confirmed with omnipaque which revealed an adequate epidurogram. 40 mg of kenalog with 4 ml of .normal saline was injected incrementally. The needle was flushed and removed intact. The patient tolerated the procedure well and was taken to the recovery room where there were observed and found to be stable before being released. Electronically Signed by: Gloria Hahn, LPN on Tuesday, Apri101, 2008 Electronically Signed by: Terrence Calder, M D on Tuesday, April O1, 2008 PatientID: AU14797 Page 4 of 4 P?,tientID: AU14797 // Patients Name: JAMES W TOMSA SR I/ MRC Description: PAIN DIAGRAM Pain Diagram of Birth: 12/25/1965 of Service: 09/16/2008 Please mark the area of injury or discomfort on the chart below, using the appropriate symbols: Numbness:----- Burning:^^^^ Pins & Needles: o00o Stabbing: 0 Q1(?~ Aching: x~c Using the pain scale 1-10, please put a number that d scribes each Best ~_ Worst (~ Current Percentage Of Improvement Since Last Visit ~' 7. ~ ~/o ~/7 ~ ~S .~ Please use the space below to describe your condition further if needed ~Z~ c C C ~ ~f~x-' Date: ~ ~ Signature: Tomsa Sr, James W Encompass Insurance Revised 2/08 DOB: 1Y/25/1983 Doctor: Terrence M Calder MD AU1I797 ~. - (.__ York Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Debra A. DeAngelo, D.O. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/16/2008 Referred from: JOHN R SCHWARTZ M D PCP: Referring Doctor: John Schwartz M D Primary Physician: Dr. John Schwartz Other physicians or providers involved with care: CHLEF COMPLAINT James Tomsa Sr is a 42 year old established patient seen in the office today. Patient is here for a scheduled procedure. The following forms were reviewed with the patient and scanned into the chart: Pain Diagram. HISTORY OF `PRESENT ILLNESS 4/1/08 New Consult :Patient involved in MVA 11/07, he was sitting on an exit ramp. He was hit from behind and pushed into the vehicle in front of him. He was a belted driver. He was treated with muscle relaxants and narcotics by his PCP till they are no longer giving him relief. His pain is bilateral low back radiating into his bilateral posterior legs into his lower legs. He does note most recently his pain is radiating into his feet. He describes his pain as: deep, numb, stinging, unbearable, burning, throbbing, band like, heavy, sharp, knife like, shooting. Increases his pain: bending over, twisting, walking. Decreases pain: relaxation. His pain does waken his at night and he does not easily return to sleep. 4/1/08 Procedure Visit: Patient has read and signed his procedure consent. 4/16/08 -Procedure Visit -Patient states that he does not feel that he had any improvement with his last injection. Pain is still located across his lower lumbar area and radiates down his legs to his feet. He did have one night where he slept through the night but he had bronchitis at the time and was on other medications which he felt helped him sleep. Procedure: Translaminar LS-S 1. Date of prior procedure:04/01/2008 Percent improvement:0 Pain levels are following treatment. Best pain (out of 10):5 PatientID: AU14797 v,,,.,, i ~~ n (. York Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/16/2008 Referred from; JOHN R SCHWARTZ M D PCP: Worst pain (out of 10):10 CuI-rent pain (out of 10):5 (__ Debra A. DeAngelo, D.O. PAST MEDICAL HISTORY: MEDICAL: Arthritis. SURGICAL: '.Right knee arthroscopy, left knee arthroscopy. right arm reconstruction surgery (hunting accident) gastric bypass. PRIOR PAIN TREATMENTS: Pain medication: muscle relaxants, narcotics. Physical modalities: none. Injection therapy: none. ~percocet, vicodin -made him very sick, skelaxin Medical history, allergies and current medications were reviewed with the patient with no changes noted. CURRENT ALLERGY LIST: PERCOCET VICODIN Is patient taking blood thimiing med?No CURRENT MEDICATION LIST: SKELAXIN ORAL TABLET 800 MG, qid VITAMIN C ORAL TABLET 1000 MG, qd MULTIVITAMIN/IRON ORAL TABLET, 1 Every Day VITAL SIGNS: VS-TEMPERATURE: 97.6°f Tympanic VS-PULSE: 90 Left Radial, Regular VS-BLOOD .PRESSURE: 148/85 Left Arm Sitting V S-RESPIRATION: 18 PatientID: AU14797 Page 2 of 4 (~-,. (~__ York Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/16/2008 Referred from: JOHN R SCHWARTZ M D PCP: V S-PULSE OXIMETRY: 97% Documentation gathered by: Lynda Hanchett. PHYSICAL EXAM: Debra A. DeAngelo, D.O. GENERAL APPEARANCE: Overweight body habitus. In no acute distress. MUSCULOSKELETAL EXAM: SPINE, RIBS, PELVIS: No tenderness. POSTURE: Normal. GAIT/STATION: Gait intact. SPECIAL TESTS: Straight leg was positive bilaterally. GENERAL EXAM: RESPIRATORY: Normal respiratory effort with symmetrical lung expansion. Lungs clear to auscultation. No adventitious sounds noted. CARDIOVASCULAR: PALPATION & AUSCULTATION: Regular rate and rhythm with no murmurs, gallops, rubs or abnormal heart sounds. ASA Physical stahis I. Physician I-IPI Cominents:continued bilateral radicular symptoms . ASSESSMENT/PLAN: 722.10-DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT 724.4-RADICULAR LOW BACK PAIN, THORACIC/L,UMBAR Assessment: His symptoms remain consistent with nerve root irritation, and may respond to an additional epidural PatientlD: AU14797 Page 3 of 4 (~ _ York Adams Pain Specialists, P.C. Terrence M. Calder, M.D. Patient was seen by: TERRENCE CALDER MD Patient Name: JAMES W TOMSA SR Date of Birth: 12/25/1965 Date of Service: 04/16/2008 Referred from: JOHN R SCHWARTZ M D PCP: injection. Plan: carry out second injection if helpful we will consider a third later if not, redirect therapy; consider surgical consult (_-_. Debra A. DeAngelo, D.O. Procethire: Translaminar (Interlaminar) Epidural. Procedure performed by Dr. Terrence Calder. Preoperative Diagnosis: radicular low back pain (724.4), herniated lumbar disc (722.10). Postoperative Diagnosis is the same. Procedure Note: The patient was taken to the procedure room and placed in a prone position. Their back was sterilely prepped with betadine. L 5-S 1 was identified with fluoroscopy, and the C-ann was adjusted to maximize the interlaminar space. The skin was anesthetized with I % Lidocaine and a 22 gauge tuohy needle was advanced with fluoroscopic guidance using loss of resistance technique via a paramedian approach. There was no CSF, heme or paresthesias. When the epidural space was located, placement was confirmed with omnipaque which revealed an adequate epidurogram. 40 mg of kenalog with 4 ml of normal saline was injected incrementally. The needle was flushed and removed intact. The patient tolerated the procedure well and was taken to the recovery room where there were observed and found to be stable before being released. Electronically Signed by: Lynda lianchett, RN on Wednesday, April 16, 2008 Electronically Signed by: Terrence Calder, M D on Wednesday, April 16, 2008 PatientID: AU14797 Page 4 of 4 PatientID: AU19797 ~~ D'` of` Hirth: 12/25/1965 Patient Name: JAMES W TOMSA SR 1 of° Service: 09/30/2008 MRC Description: PAIN DIAGRAM Pain Diagram Please mark the area of injury or discomfort on the chart below, using the appropriate symbols: Numbness:----- Burning:^^^^ Pins & Needles: o00o Stabbing: 0 0 0 Aching: ~c Using the pain scale 1-10, please put a number that dlescribes each Best ~ V/orst ~ Current "~ Percentage Of Improvement Since Last Visit Please t 2 ~~ ~~ Z ~ /3~ ~ ~ ~~ e~ the space below to describe your condition fiu~ther if needed `/ ~ Date: y ~~s Signature• ~.~.~~ Tomsa Sr, James W Encompass Insurance D06: 1?/2S/1965 Revised 2/OS Doctor: Terrence M Calder MD AW4797 EXH/BlT "E" ORTHL~~EDIC INSTITUTE pF P~NNSYL'~?NNIA (717) 761-5530 ?atient: James W. )OB: 12f2S/65 6/11/2008 OB~ICB VISIT Tomsa Chart #: 02917141 SSN: 164 64 2493 Page ## 1 RONALD W. LIPPE, Di.D. i had the pleasure of meeting your patient James Tomsa in the Trindle Road Office on June 11, 2008 regarding hig back. HISTORY OF COMPLAINT: He is a very nice 42 year old gentleman. He was well until 11/4/07 when he was involved in a motor vehicle accident. He was the restrained driver that was stationary when his car was struck from behind at SO MYH. Since then he has-had difficulty with pain in his back. The pain is in his low back with radiation .down both lower extremities and i8 worse with activities. xe tried golfing but was unable to do so secondary to his pain. He has received two epidural injections to this point with slight improvement. He comes in today for evaluation after getting an MRI. REVIEW OF SYSTEMS: Review of systems, past medical history, family history and social history have been recorded and reviewed. PHYSICAL EXAMS He is a healthy appearing gentleman in no acute distress.. Range of motion of his lumbar spine is slightly decreased. Neurologically hP is intact. in his lnwPr extrPmiti.es. Reflexes are present in his patellae and Achilles. His extensor hallucis longue is strong bilaCerally. He has good rotation of both hip9. Al.ignmPnt of his lumt3ar spine is satisfactory. His skin is normal. DIAC3NOSTIC TESTS: I reviewed his MRI report which states some deyeneraLive changes and bulging disc but no frank spinal canal compromise or neurologic compression. DIAGNOSIS: I explained to him that he has mechanical low back pain from his acceleration injury to his lumbar spine. PLAN: we discussed treatment options. He is going to try a course of physical therapy and I wrote a prescription for that. I told him to give this several weeks to improve. I will see him back in 2 months to check his progress. Thanks very much far allowing me to participate in the care of this very nice geritlemdn. RWL/skb RiNL LgTTERS (Ref} SCHWART2, Q.O., JOHf} 8/13/2048 RONALD i9. LIPPS, M.D. MISSED APPT LETTER (Pat} TOMSA, JAMES W. 1/23/2004 RONALD QQ. LIPPE, M.D. TEL/D~SG-NUR5 T8L CALL James called the office today because his back pain has flared up. It has E~CH/BI T "F" Exam./Ninosky - Tomsa 22 24 1 ambulance, too. 1 Q. Do you remember the name of the group in York 2 Q. What did she do to her wrist? 2 that you went to? 3 A. Bruised, and her knee, I believe it was also her 3 A. York arthopedic specialists, OSS. 4 knee, too, pretty much bruised up pretty good. 4 Q. Do you remember how long from the time-- You 5 Q. And did you exit the vehicle before the 5 weren't admitted to the hospital at Harrisburg, 6 emergency folks came? 6 correct? 7 A. No. 7 A. No. 8 Q. You stayed in your seat? 8 Q. When did you see Dr. Schwartz then after you 9 A. Yes. 9 left Harrisburg Hospital? 10 Q, Do you have any sort of conception of time 10 A. I can't recall the exact date. 11 before help would have amved? 11 Q. Was Mrs. Conklin correct? Was it Friday when 12 A. I'd say 10 minutes at the most. It was-- It 12 this accident happened? 13 seemed very, very quick. It was a flash 13 A. Yes, November, yes. 14 honestly. 14 Q. Would it be fair to assume that you would have 15 Q. And during whatever time period that we're 15 sought treatment-- 16 talking about from the time of the accident 16 A. I had to follow up with him, and then I had to 17 until the emergency personnel arrived, did your 17 wait to get into the orthopedic, OSS. 18 condition change at all? You had said you had 18 Q. Would have seen Dr. Schwartz probably the 19 pain basically from your head to-- 19 following week? 2 0 A. Just I could feel myself getting stiff and, you 2 0 A. Yes, I think it was a couple weeks. 21 know, rightfully so. 21 Q. Did Dr. Schwartz do anything as far as ordering 2 2 Q. And my understanding is you did go to the 2 2 tests or such? 2 3 hospital in an ambulance. Is that correct? 2 3 A. Yeah, he did, also, correct. 2 4 A. That's correct. 2 4 Q. What did he order? 2 5 Q. Was it Harrisburg Hospital, do you remember? 2 5 A. CAT scan. 23 25 1 A. That's correct. 1 Q. Did he share with you what the results of the 2 Q. We have medical records, so, you know, the 2 CAT scan were? 3 records say what they say. I'm just going to 3 A. Yes. 4 ask you what your general understanding and 4 Q. What were those results? 5 recollection is, okay? 5 A. Two lower discs from he had somebody read them, 6 A. Sure. 6 bulging. 7 Q. What did they do for you at Harrisburg Hospital? 7 Q. Do you remember what part of your spine would 8 A. Neck brace, did X-rays, and they recommended a 8 have had-- 9 orthopedic doctor after that. 9 A. The lower. And that's where I had the pain, and 10 Q. Do you remember whether the X-rays showed 10 it's still today. 11 anything abnormal injury wise that they shared 11 Q. Can you show me low back? 12 with you? 12 A. Yes, very low back, um-hum. 13 A. No. 13 Q. And that was going to be my question, from the 14 Q. Who did they recommend as far as for an 19 time you left Hamsburg Hospital until you 15 orthopedic consult? Was it anyone that they 15 would have sought treatment with Dr. Schwartz, 16 said or they just told you to find somebody to 16 was there any change in the pain or symptoms 17 go to? 17 that you were feeling, either got worse, got 18 A. That I can't recall. I would go to who I would 18 better? 19 want to go to, though, and that's what I did. 19 A. It started getting worse around Christmastime, 2 0 Q. And where did you go? 2 0 and that's really when I started pushing 21 A. I went to my family doctor first, and he 21 everything, you know, with, you know, what am I 2 2 recommended the group in York. And then I went 2 2 going to do here, I can't go back into my normal 2 3 from -- I went to them. 2 3 routine of things. And I understand it takes 2 9 Q. And your family doctor at the time? 2 4 time. Muscle strains and pulls take a lot 2 5 A. Was Dr. Schwartz. 2 5 , longer. I've always played sports. I 7 (Pages 22 to 25) Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 r~ Exam./Ninosky - Tomsa 26 28 1 understand that. So that's why I waited so long 1 A. The exercises I was given and the shots in the 2 before I even got an attorney or anything to 2 back. 3 look at because I understand things take time. 3 Q. When was the last time you would have received 4 But when they weren't getting any better, that's 4 the shot, or when was the second shot I should 5 when I kept seeking medical treatment. 5 say? 6 Q. And it was neck and back that were causing the 6 A. Two years ago now. 7 problems? 7 Q. Was that the last time you had any active 8 A. The neck seems to be fine, a little stiff here 8 treatment for your back? 9 and there, you know. That's with age, I'm sure. 9 A. I just went a few weeks ago to my doctor, and he 10 But my lower back is the issue, and it's-- It 10 gave me some exercises. And I went back to OSS, 11 is what it is. I mean, I'm just, you know. 11 and the same thing, you know, he said I'm doing 12 Q. And what is it? Tell me what you're feeling in 12 a lot-- Since the accident, I've dropped over 13 your lower back. 13 50 pounds. I'm trying to lose the weight around 14 A. I just can't-- I can't do the same thing. I 14 that, too, but nothing I do is going to cure 15 don't sleep the way I used to sleep prior to the 15 this. And getting older, too, I know that it's 16 accident. You know, I used to sleep on my back. 16 part of nature, too, but that accident is, you 17 I don't sleep on my back anymore. I sleep on my 17 know, what occurred. I mean, before that I was 18 side. If I roll over, I know it. I'm wide 18 able to do everything I wanted to do, and since 19 awake. I get up, do the normal guy thing, go to 19 then, I can't do exactly what I was doing 2 0 the bathroom, come back and try to lay back down 2 0 before. 21 and at least rest. And I sleep four or five 21 Q. Did you have a gastric bypass? Did I see that? 2 2 hours, you know, a day if I'm lucky and, you 2 2 A. Yes. 2 3 know, so be it. You know, I can function, but I 2 3 Q. When was that? 2 4 get to work and Idrink-- I drink a lot more 2 4 A. That was back in '9 -- or wait, 20 -- let me 2 5 coffee than I used to. 2 5 think -- '04, 'OS that range there. I have to 27 29 1 Q. Neck pain's gone, but the back pain is what's 1 look at the exact date. 2 still bothering you? 2 Q. How much weight were you able to lose as a 3 A. Absolutely, yes. 3 result of that procedure? 4 Q. What treatment have you received for the back 4 A. A hundred pounds. 5 pain? 5 Q. Did you say you're still losing weight? 6 A. Specific exercises from my family doctor, 6 A. Yes. 7 medications, several different medications, and 7 Q. What was the ultimate goal as far as weight 8 the reason is I had allergic reactions, too. I 8 loss? 9 could never be a druggie, which is a good thing, 9 A. Under 200 pounds. 10 but some of the drugs I can't take. Percocet 10 Q. Since you're a guy, I can ask you the question, 11 and things like that I regurgitate them back. 11 what's your weight now? 12 So now what they've done is they've given me 12 A. 228. 13 medicine now to take with them that won't make 13 Q. You're getting close. 14 me -- make my stomach upset, but I can't take 14 A. I'm-- Yep, I'm working on it. 15 anything strong. I usually ask for Tylenol with 15 Q. At the time of the crash what was your weight 16 codeine. 16 approximately? 17 And I received two shots in my back to try 17 A. 275, 285. I had gained some of it back and 18 to help with that, and it just didn't do 18 things, too. 19 anything. And I thought, well, no reason for 19 Q. But still you've been able to lose about 2 0 her insurance or my insurance to have to pay for 2 0 50 pounds, give or take, from the time of the 21 that if it's not going to work. 21 crash? 2 2 Q. Did you have any physical therapy? 2 2 A. Correct. 2 3 A. No. 2 3 Q. Is there any healthcare provider that you 2 4 Q. Just the exercises that you were given to do at 2 4 received treatment for injuries related to the 2 5 home? 2 5 accident that you haven't told me about yet? 8 (Pages 26 to 29) Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 ~~ . J Exam./Ninosky - Tomsa 30 1 A. From the accident? 2 Q. Yes. 3 A. Yes. 4 Q. Who? 5 A. I did go see the group that Dr. Rubin used to be 6 with, and that is Orthopedic Institute, 7 Camp Hill. 8 Q. How many times did you go to OIP? 9 A. I went once. 10 Q. For a second opinion or what was the purpose to 11 go there? 12 A. Yes, for a second opinion, see what they 13 thought, also. 14 Q. What did they-- First of all, who did you see, 15 and, second, what were you told? 16 A. Dr. Lippe. 17 Q. What did ]h. Lippe tell you? 18 A. Pretty much the same thing OSS did, you're going 19 to have to live with this, you're too young, we 2 0 don't want to operate, which is-- I didn't want 21 an operation. I don't want an operation. I've 22 had enough knee surgeries to last me a lifetime. 2 3 Q. What medications are you taking now? 2 4 A. Just pain pills when I need them, and that's 2 5 after I do any long, you know, activities, ~i 1 2 3 4 5 t 6 7 8 9 , 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 9 (Pages 30 to 33) Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 ~ ~ . r CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Motion for Summary Judgment has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on June 25, 2010: David M. Pollick, Esquire Law Offices of Dale E. Anstine, P.C. Two West Market Street P.O. Box 952 York, PA 17405 JOHNSON, DUFFIE, STEWART & WEIDNER By: ~ ~ ~, l~ ,c~-~ Joh R. Ninosky, Esquire cry/ac. PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be typewritten and submitted in duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: (List the within matter for the next Argument Court.) CAPTION OF CASE (entire caption must be stated in full) JAMES W. TOMSA, Plaintiff VS. NANCY CONKLIN, Defendant C`> c o Q ,~, ~ -e r-~.: c.._ c - ~: rr ; ~ ;,1r:. u. tf ~ ~' ~ -~; s-r~ ~7 ~ 4. 3 ti..~ G -, ~`y~~~ .._i _, { ~~ ~ ~j =~^a z ~~. No. 09-468 , _ Civik~erm~ State matter to be argued (i.e., plaintiffs motion for new trial, defendant's demurrer to complaint, etc.): Defendant Conklin's Motion for Summary Judgment 2. Identify counsel who will argue cases: (a) for plaintiffs: David M. Pollick. Esouire. Law Offices of Dale E. Anstine. P.C.. Two West Market Street. P.O. Box 952. York. PA 17405 (Name and Address) (b) for defendant: John R. Ninoskv, P.O. Box 109, Lemoyne, PA 17403 (Name and Address I will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: August 18, 2010 S' nature John R. Ninoskv Print your name Attorney for Defendant Delozier Date: June 25, 2010 INSTRUCTIONS: 1. Two copies of all briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) before argument. 2. The moving party shall file and serve their brief 12 days prior to argument. 3. The responding party shall file their brief 5 days prior to argument. 4. If argument is continued new briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) after the case is relisted. of ~-r~ ~ - L ~i- i~~ Z~iQ~"~ 15 t~ ~: i< ~" ~ i .; iii: , ". `;',~t. t'r, .- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JAMES W. TOMSA, Plaintiff N0.2009-4681 Civil Term v. CIVIL ACTION -LAW NANCY CONKLIN, JURY TRIAL DEMANDED Defendant PLAINTIFF'S RESPONSE TO DEFENDANT'S MOTION FOR SUMMARY JUDGMENT 1-5. Admitted. 6. Admitted that one of the enumerated exceptions to the limited tort option is a serious impairment of a body function. 7-8. The allegations of paragraphs 7 and 8 of Defendant's motion for summary judgment constitute legal conclusions and are therefore denied. 9. Denied as stated. Plaintiff is a he not a she. Defendant's statement that the DALId E^ANBTIN>d. P. C. Yo¢a, Paxx`1cc vsreu5~aaos medical records attached as Exhibits B through F to the motion for summary judgment only contain the diagnosis of a "C-spine strain" are incorrect. Exhibit 13 is the EMS repors which notes back pain and neck pain. Exhibit D is an office note from Hillside Pain Management, PC dated April 1, 2008 at which time the Plaintiff was seen by Terrence Calder, MD. The history provided to Dr. Calder by the Plaintiff is having been involved in a motor vehicle accident in November, 2007 and he was complaining of pain in his bilateral low back radiating into his bilateral posterior legs and into his lower legs. It is noted that Plaintiff underwent an MRI of his lumbar spine on March 12, 2008 which revealed bulging discs at multiple levels of his lumber spine. Dr. Calder's diagnosis on April 1, 2008 was radicular low back pain, thoracic/lumbar, and displacement of lumber intervertebral disc. Exhibit D also contains an April 16, 2008 office note from Dr. Calder wherein Plaintiff continues to complain of low back pain radiating into his legs and into his feet. Dr. Calder notes that straight leg raising was positive bilaterally. Plaintiffs symptoms remained consistent with a nerve irritation and he recommended epidural steroid injections at the LS-S1 level. Exhibit E attached to Defendant's motion for summary judgment is an office note from Orthopedic Institute of Pennsylvania dated June 11, 2008 when Plaintiff saw Ronald W. Lippe, NID. Dr. Lippe notes he was seeing the Plaintiff regarding his back. He notes the history of the motor vehicle accident on November 9, 2007. Dr. Lippe reviewed the MRI, noted the bulging discs, and diagnosed Plaintiff with mechanical low back pain from his acceleration injury to his lumber spine. While Exhibit F is referenced in paragraph 9 of Defendant's motion for summary judgment, it is not a medical record but is a portion of Plaintiff's deposition transcript. Defendant failed to attach any medical records from Orthopaedic & Spine Specialists. 10. Denied. To the contrary, Plaintiff has sustained a serious impairment of a body function. 11-13. Admitted. 14. Denied. It is denied that Plaintiff cannot recover non-economic damages in this DALHI E•AxeT~x~. P. f'. You, Pex..iccv 'u ~~aoe case. To the contrary, Plaintiff meets the exception to limited tort concerning serious impairment of a body function. Defendant references Plaintiff's deposition transcript which is attached as Exhibit F. Plaintiff s deposition testimony reveals that he has sustained a serious impairment of a body function. 15. Admitted. WHEREFORE, Plaintiff respectfully requests that the Defendant's motion for summary judgment be denied. RESPECTFULLY SUBMITTED: LAW O~F`I~E OF DALE E. ANSTINE, P.C. David M"Pollick, Esquire Attorney ID No. 34368 2 West Market Street Post Office Box 952 York, PA 17405-0952 (717) 846-0606 (717) 845-7431 Facsimile dpollick@4anstine.com DAL7C E.~ARBT[iv~. P. ('. Yoae, Pentaevcvwwug~>aoo IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JAMES W. TOMSA, Plaintiff v. NANCY CONKLIN, Defendant N0.2009-4681 Civil Term CIVIL ACTION -LAW JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW, this ~ day of J ~ 2010, I, David M. Pollick, Esquire, a member of the Law Offices of Dale E. Anstine, P.C., hereby certify that I have this date served a copy of the within and foregoing document by First Class United States Mail, postage pre-paid addressed to the party or attorney of record as follows: John R. Ninosky, Esquire Johnson Duffie 301 Market Street PO Box 109 Lemoyne, PA 17043-0109 RESPECTFULLY SUBMITTED: LAW E. ANSTINE, P.C. David M. Polack, Esquire Attorney for Plaintiff DA LH E. ANSTINH• Y. C. Yovz, Paxxevcvwxu ~~aoa PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be typewritten and submitted in triplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: (List the within matter for the next // Argument Court.) r:jl-# A'1. CAPTION OF CASE (entire caption must be stated in full) JAMES W. TOMSA VS. NANCY CONKLIN y Q 4 i ~ ~_ ~, c_ =Y __> ~, `r~ l_ ~~ t._ __,_ . No. 09-4681 Civil ~Terrn.. _ ` L~ 1. State matter to be argued (i.e., plaintiffs motion for new trial, defendant's demurrer to complaint, etc.): Plaintiff Tomsa's Motion for Summary Judgement 2. Identify all counsel who will argue cases: (a) for plaintiffs: David M. Pollick, Esquire. Law Offices of Dale E. Anstine, P.C. 2 West. Market Street (Name and Address) York, PA 17401 (b) for defendants: John R. Ninosky, Esquire, P.O. Box 109, Lemoyne, PA 17403 (Name and Address) 3. I will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: August 18, 2010 David M. Pollick Print your name Plaintiff Tomsa July 13, 2010 Date: INSTRUCTIONS: 1. Original and two copies of all briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary} before argument. 2. The moving party shall file and serve their brief 12 days prior to argument. 3. The responding party shall file their brief 5 days prior to argument. 4. If argument is continued new briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) after the case is relisted. Attorney for JAMES W. TOMSA, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION -LAW NO.09-4681 CIVIL NANCY CONKLIN, Defendant JURY TRIAL DEMANDED 1N RE: DEFENDANT' S MOTION FOR SUMMARY JUDGMENT BEFORE HESS P.J. OLER AND MASLAND, J.J. ORDER AND NOW, this 2 /~ day of September, 2010, the motion of the defendant for summary judgment is DENIED. BY THE COURT, /q~ Kevin .Hess, P. J. avid M. Pollick, Esquire For the Plaintiff John R. Ninosky, Esquire For the Defendant :rlm Ca c Fs M~1, ~~t~- I ql~~~w ~~ -:> :, ~~, :' ..., ,r,--~ _:; ;_ a ~ - ~mr c~ ~ C'r `~ ;~,yr_ N ~! ~1 ~.. C.°, . <:. JAMES W. TOMSA, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION -LAW NO. 09-4681 CIVIL NANCY CONKLIN, Defendant JURY TRIAL DEMANDED IN RE: DEFENDANT' S MOTION FOR SUMMARY JUDGMENT BEFORE HESS, P.J., OLER AND MASLAND, J.J. OPINION AND ORDER This matter stems from a motor vehicle accident that occurred on November 9, 2007, when Nancy Conklin's (Defendant) vehicle hydroplaned on the exit ramp from Route 581 to Route 15 in Camp Hill, Pennsylvania, and struck the rear of James Tomsa's (Plaintiff) vehicle. At the time of the accident, plaintiff had an automobile insurance policy with Encompass Insurance and was covered under the "Limited Tort" option on his policy. The EMS report reveals that, on the date of the accident, plaintiff complained of back and neck pain, but did not appear to be in any distress. Following the accident, plaintiff was transported to Harrisburg Hospital. According to the final report from the Harrisburg CT Department, plaintiff was diagnosed with degenerative changes without evidence of acute abnormality. Straightening of the cervical spine was noted, either relating to positioning or muscle spasm. Plaintiff was discharged from the ER with a diagnosis of a C-Spine strain and a left hand contusion. On April 1, 2008, plaintiff was seen by Dr. Terrance Calder. Dr. Calder's diagnosis was radicular low back pain and a herniated lumbar disc. Dr. Calder proceeded to administer to plaintiff a translaminar (interlaminar) epidural injection. On April 16, 2008, plaintiff was again seen by Dr. Calder. Plaintiff continued to complain about low back pain, alleging no NO. 09-4681 CIVIL improvement from the aforementioned injection. Plaintiff subsequently received a second epidural steroid injection. On June 11, 2008, plaintiff was treated by Dr. Ronald Lippe, who reviewed plaintiff's MRI report, which indicated some degenerative changes and bulging disc, but no spinal canal compromise or neurologic compression. Dr. Lippe diagnosed plaintiff as having mechanical low back pain from his acceleration injury to his lumbar spine. Dr. Lippe prescribed plaintiff a course of physical therapy. Plaintiff claims that he has suffered a lower back injury as a result of the accident. He testified that his neck seems to be fine, but his lower back continues to cause him pain. Plaintiffs treatment has included Tylenol with codeine, two injections in his back and physical therapy. At the time of his deposition, plaintiff was taking pain pills, which became necessary following long periods of activity. This action began with plaintiffs filing of a complaint on August 3, 2009. Defendant filed her answer with new matter on September 22, 2009. Plaintiff filed a reply to defendant's new matter on October 13, 2009. The pleadings and relevant discovery are closed. Defendant has filed a motion for summary judgment asking that all claims asserted against her be dismissed with prejudice by virtue of the fact that plaintiff s insurance coverage was pursuant to a limited tort option. Pennsylvania law provides that summary judgment may be granted only in those cases in which the record clearly shows that no genuine issues of material fact exist and that the moving party is entitled to judgment as a matter of law. The moving party has the burden of proving that no genuine issues of material fact exist. In determining whether to grant summary judgment, the trial court must view the record in the light most favorable to the non-moving party and must 2 NO. 09-4681 CIVIL resolve all doubts as to the existence of a genuine issue of material fact against the moving party. Thus, summary judgment is proper only when the uncontroverted allegations in the pleadings, depositions, answers to interrogatories, admissions of record, and submitted affidavits demonstrate that no genuine issue of material fact exists, and that the moving party is entitled to judgment as a matter of law. In sum, only when the facts are so clear that reasonable minds cannot differ, may a trial court properly enter summary judgment. Wright v. Allied Signal, Inc., 963 A.2d 511, 514 (Pa.Super. 2008) (citing Gutteridge v. A. P. Green Services, Inc., 804 A.2d 643, 651 (Pa.Super. 2002)). An individual who selects the Limited Tort option is precluded from recovering non- economic damages unless an injury causes a "serious impairment of a body function." See, 75 Pa.C.S.A. § 1705. The "serious impairment of body function" threshold contains two inquiries: (1) what body function, if any, was impaired because of injuries sustained in a motor vehicle accident; and (2) was the impairment of the body function serious. Washington v. Baxter, 719 A.2d 733, 740 (Pa. 1998). Several factors must be considered to determine if the claimed injury is "serious": (1) the extent of the impairment; (2) the length of time the impairment lasted; (3) the treatment required to correct the impairment; and (4) any other relevant factors. Graham v. Campo, 990 A.2d 9, 16 (Pa.Super. 2010). The Pennsylvania Supreme Court in Washington, 719 A.2d at 740, stated that the ultimate determination as to whether a limited tort elector has sustained a serious injury should be made by a jury in all but the clearest of cases. The threshold determination must be left to a jury unless reasonable minds could not differ on the issue of whether a serious injury has been sustained. Id. In the case sub judice, we are satisfied that reasonable minds on the jury could disagree as to whether plaintiffs injury constitutes a serious injury. 3 NO. 09-4681 CIVIL Defendant cites to Murray v. McCann, 658 A.2d 404 (Pa.Super. 1995), a case in which the plaintiff was struck by a motorist and suffered neck and back pain requiring several months of physical therapy. The plaintiff was treated with ibuprofen. The court determined that the plaintiff did not suffer a serious impairment of a body function, when she could perform all her daily activities, she did not have to take breaks from work for her pain, her doctor told her she would lead a normal life, albeit with a "measure" of pain, and she received no further medical treatment beyond eight months from the date of the accident. Defendant argues that since the accident the plaintiff, in this case, has not experienced a significant decrease in the types of activities he is able to perform. Defendant notes that plaintiff has the same job and performs the same activities as he did before the accident, albeit with a lower level of intensity. Defendant argues that similar to the plaintiff in Murray, plaintiff has undergone physical therapy and has taken medications. In both cases, surgery was unnecessary. Finally, defendant points out that plaintiff has not received medical treatment since June 1 I, 2008 (just over seven months after the date of the accident).1 Although some of the facts relating to the injury in Murray are similar to those in this case, there are others tending to show a more serious injury. For example, plaintiff testified that there are some activities he participated in prior to the accident which he no longer does at all. Plaintiff testified that prior to the accident he was an avid golfer, participating in six to eight golf tournaments per year. Now he is fortunate if he can play in two tournaments per year. Plaintiff ~ In plaintiff s brief in opposition to defendant's motion for summary judgment, plaintiff attached an office note from Orthopedic & Spine Specialists, indicating that plaintiff was treated for his back injury on February 18, 2010. Plaintiff was seen by Dr. Steven K. Groff, MD. As noted in the office report, plaintiff continues to suffer from lumbar radiculitis and lumbar disc disease. Dr. Grof~'recommended another steroid injection at the L4 and LS levels, and noted that plaintiff's sciatica and lumbar problems continue to be exacerbated. The attachment of this letter to the brief is problematic because it is not, thereby, made a part of the record. z Activities which plaintiff no longer participates in allegedly due to the extent of his injuries include: Tuesday night basketball; lifting weights; mowing lawn; climbing a tree stand; and hunting with a compound bow. 4 NO. 09-4681 CIVIL also testified that prior to the accident he would go trout fishing as often as possible (at least a couple of times per week during fishing season). As of the date of his deposition, plaintiff claimed he had only gone once in 2010. In addition, plaintiff testified that his sleeping habits have been greatly affected, and that since the date of the accident he sleeps only four or five hours per night. He further alleges that his lower back pain continues to affect him. Although almost three years have passed since the date of the accident, plaintiff still has limitations and is still undergoing treatment. Giving the plaintiff the benefit of all inferences to be drawn from the evidence, we are satisfied that reasonable minds could differ as to whether plaintiff's injuries constitute a serious injury for purposes of the limited tort threshold requirement. ORDER AND NOW, this Z ~ ` day of September, 2010, the motion of the defendant for summary judgment is DENIED. David M. Pollick, Esquire For the Plaintiff John R. Ninosky, Esquire For the Defendant :rlm 5 BY THE COURT, C~~ 1 PRAECIPE FOR LISTING CASE FOR TRIAL (Must be typewritten and submitted in triplicate) ~.~ ~; TO THE PROTHONOTARY OF CUMBERLAND COUNTY -vim c~ ~ ~ Please list the following case: ~~ ~ . ^X for JURY trial at the next term of civil court. ~~ --t ~~ ~ ^ for trial without a jury. ~~ ,~- c.a - CAPTION OF CASE ~ Z d-ri (entire caption must be stated in full) (check one) ~ ~ _: X^ Civil Action -Law ~ - ;~ James W. Tomsa ^ Appeal from arbitratio~rt ~ ts~ ~ ^ ~ (other) (Plaintif fl vs. The trial list will be called on 1/4/11 Nancy Conklin and Trials commence on 1/31/11 (Defendant} Pretrials will be held on 1119/11 vs. (Briefs are due 5 days before pretrials No. 09-4681 ~ Civil Term Indicate the attorney who will try case for the party who files this praecipe: John R. Ninosky, Esquire, Johnson, Duffle, Stewart & Weidner, P.C. Indicate trial counsel for other parties if known: David M. Pollick, Esquire, Law Offices of Dale E. Anstine, P.C. This case is ready for trial. Print Name: John R. Ninosky Date: 10!13110 Attorney for: Defendant p0 ~~~ ~~ ~~ 0~~` ~ 3~0,~~~ ~-~ ~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JAMES W. TOMSA, Plaintiff V. NANCY CONKLIN, Defendant I? To the Prothonotary: I CIVIL ACTION - LAW NO. 09-4681 CIVIL, JURY TRIAL DENfANDED -.y.. 7 f --._ PRAECIPE TO DISCONTINUE Please mark the above-captioned action settled and satisfied. LAW 001CES OF. F5, ANSTINE By Davitd M. Pollick, Esq. 2 W. Market St., P.O. Box 952 York, PA 17405 (717) 846-0606 Supreme Court ID: 34368 wo.F E of I Dated: --5--t441 DALE Yoaa `PennxvA eyx ?nVi N?...